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LIBRARY 

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: FROM THE ROOM. 



A History of Nursing 

From the Earliest Times to the Present Day 

with Special Reference to the Work of 

the Past Thirty Years 



Edited, and in Part Written, by 

Lavinia L. Dock, , R* N, , 

. ^ 

Secretary of the Internadonal Council of -Nlirses, ^Graduate of 

Belle vue Training School, New. York City 

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In Four Volumes 
Volume III 







With 43 



G. P. Putnai 

New York and London 
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1912 



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PREFACE 

THE construction of the final volumes of A History 
of Nursing has proceeded on somewhat differ- 
ent lines from those followed in the first and second 
volumes. The collaboration of Miss Nutting has 
not been possible in finishing the task, because of 
the demands of her work as head of the Department 
of Nursing and Health at Teachers College. She 
has, however, with unabated interest given help and 
advice in ways open to her, which we gratefully ac- 
knowledge. The editor, therefore, in undertaking an 
account of the modern nursing movement, has sought 
and received in abundant measure the assistance of 
nurses in all those countries here dealt with. That it 
has been possible to do this so easily and directly as 
was the case, to meet with instant and ready response 
and unfailing co-operation, is one of the fine fruits 
of international friendship and comradery grown 
from the International Council of Nurses conceived 
and founded in London, in 1899, by Mrs. Bedford 
Fenwick, whose fertile genius for organisation has 
been felt as a potent stimulus among nurses of almost 
every country of the world where modern skilled 
nursing has come into being. 

The editor herself has undertaken the preparation 
of several of the chapters, with the subject matter of 



vi Preface 

which she felt most familiar, while others have been 
partly or entirely prepared, by individuals or by 
groups, in the countries from which they come. 
Those arranged by the editor have been sent to the 
countries they concern, to be read and criticised by 
nurses prominent in the modern movements there, 
and, with those prepared abroad, the editor in turn 
has added to or taken from, according to her best 
judgment, or has reshaped in order to fit the general 
plan. Not willingly has she entirely rewritten any 
parts of collaborative material, but this has had to be 
done sometimes, because of the necessity of shorten- 
ing down to the alloted number of pages. For this 
reason, too, many details of interest and importance 
to their several countries have had to be cut out, 
and the editor wishes here to express to her collabora- 
tors her regret at this necessity, and to offer to the 
general reader the explanation that the various 
collaborators are not to be charged with omissions 
or imperfections discoverable by criticism. 

In general, the plan followed in the selection of 
material has been to give as much fulness as possible 
to beginnings, and to those aspects of our subject 
which cannot easily be read of elsewhere. "There 
are important aspects of modern nursing which may 
seem to have been slighted here, such as visiting 
nursing and tuberculosis work, but they have his- 
tories or records of their own. Again, many prob- 
lems of great professional importance, such as private 
nursing with its attendant evil of commercial 
agencies and its hopeful outlook through central, 
professionally controlled clubs and directories; in- 
stitutional work and its status, and, even more 



Preface vii 

serious, the vast influx of young girls, of faulty 
rearing and imperfect education, into nursing, with 
the consequent dilution of standards, many such 
problems have been left untreated, not because their 
importance has been overlooked, but for want of 
space to do them justice. Such problems are always 
with us, and in our professional press we have a 
forum for their discussion. The advance in self- 
governing organisation, on the other hand, with its 
plea for state registration, may be thought to have 
an undue share of space, but this movement is new 
and of great significance, resulting from the incessant 
efforts of women who have had no time to write 
down the history they have made and are busy 
making. 

The editor assumes full responsibility for the 
interpretation or colour of the narrative and for 
personal touches. As to the former, however, she 
believes that her point of view coincides with that 
generally held by the groups of leaders or M progres- 
sives" in the various countries. 

It had been intended to add a complete biblio- 
graphy, but space forbids, and only a partial list 
of references has been selected. 

Those to whom thanks are due for labours of 
collecting, preparing, or revising material are, first, 
the officers of the national groups and Mrs. Bedford 
Fen wick, Honorary President, International Council 
of Nurses; Miss Margaret Breay, Councillor and 
Treasurer, International Council of Nurses; Miss 
Amy Hughes, General Superintendent, Queen Vic- 
toria's Jubilee Institute for Nurses; Miss Gill, 
Lady Superintendent, Edinburgh Royal Infirmary; 



viii Preface 

A Committee of Irish Matrons; A Committee of 
Swedish Nurses; The Danish Nurses' Association; 
Baroness Sophie Mannerheim, Lady Superintendent, 
Surgical Hospital, Helsingfors, Finland; Mrs. M. 
Louise Lyman, Ottawa, Canada; Miss Alice R. 
Macdonald, Sister, Melbourne Hospital, Australia; 
Miss Ellen J. Gould, Matron, Private Hospital, 
Australia ; Miss Hester Maclean, Assistant Inspector 
of Hospitals and Deputy Registrar of Nurses under 
the government of New Zealand ; Miss Mabel McCal- 
mont, late Chief Division of Hospital Construction 
and Equipment, Bureau of Health, Philippine Is- 
lands; and Miss M. Eugenie Hibbard, Department 
of Health, Havana, Cuba. 

A special contributor to the Irish material was 
Dr. Kirkpa trick of Dublin, who placed his own his- 
torical studies at our disposal, while Father Rushe, 
author of A Second Thebaid took trouble to supply 
helpful references. Our sorrow at the loss of Mrs. 
Kildare Treacy lends peculiar importance to her un- 
failing interest in the book. Up to the time of her 
last illness she was untiring in her correspondence 
in behalf of the Irish chapter. 

Especial thanks are also due to the Dowager 
Marchioness of Dufferin and Ava, for the loan of 
her own reports of her work in India, and to Mrs. 
Etha Butcher Klosz, editor of the Nurses Journal 
of India, for a specially laborious piece of work in 
collecting material on nursing in that country. 
The data on registration in the United States have 
been supplied by the officers of the State Societies 
of Nurses, while Miss Palmer, editor of the American 
Journal of Nursing, placed at our disposal her own 



Preface ix 

records and correspondence relating to the inception 
of registration in New York State. 

The editor hopes that her work may stimulate 
others to fill in the general outline here presented, 
by writing the history of nursing in individual coun- 
tries, for then it will be possible to place on record 
many valuable and interesting details which cannot 
be included in our limited pages, but which have 
professional and human importance and deserve to 
be known by our successors. 

LAVINIA L. DOCK, R. N. 



CONTENTS 

PAGE 

CHAPTER I 

THE STORY OF THE NURSES OF GREAT BRITAIN 

AND IRELAND ...... I 

CHAPTER II 
'THE GROWTH OF NURSING IN THE UNITED STATES Il6 

CHAPTER III 
NURSING IN THE COUNTRIES OF NORTHERN EUROPE 237 

CHAPTER IV 
THE REVOLUTION IN FRENCH HOSPITALS . . 279 



ILLUSTRATIONS 

PAGE 

ETHEL GORDON FENWICK . . Frontispiece 

Founder and Leader of Organisation in the Nursing 
Profession ; Founder of the International Council of 
Nurses ; Editor of the British Journal of Nursing. 

GERTRUDE ROGERS . . . . . .16 

Matron, Leicester Infirmary. 

BEATRICE CUTLER . . . . . .16 

Assistant Matron, St. Bartholomew's Hospital, London ; 
Hon. Secretary, National Council of Trained Nurses of 
Great Britain and Ireland. 

AMY HUGHES ....... 22 

General Superintendent, Queen Victoria's Jubilee Insti- 
tute for Nurses. 

WlLHELMINA MOLLETT ..... 22 

Late Matron, Royal South Hants Hospital. 

HELEN L. PEARSE . . . . . .28 

First Superintendent of School Nurses under the London 
County Council. 

MRS. LANCELOT ANDREWS .... 28 

One of the first inspectors of maternity wards, nurseries, 
and infirmaries under the Local Government Board. 

SISTER S. E. CARTWRIGHT .... 50 

Secretary and Sister-in-Charge, Registered Nurses' 
Society. 

xiii 



xiv Illustrations 

PAGE 

MARGARET BREAY ...... 50 

Assistant Editor, British Journal of Nursing ; Treasurer 
International Council of Nurses ; Secretary, Matrons' 
Council of Great Britain and Ireland. Taken when Staff 
Nurse, St. Bartholomew's Hospital. 

I SLA STEWART ...... 52 

Late Matron, St. Bartholomew's Hospital. President, 
Matrons' Council of Great Britain and Ireland ; and 
Councillor, International Council of Nurses. 

LOUISA STEVENSON, LL.D., Scotland . . 56 

First President, Society for State Registration of Trained 
Nurses. 

'THE BURIAL OF FLORENCE NIGHTINGALE . . 60 

Her casket was carried by soldiers of the Guards which 

had been represented in the Crimea. 

By courtesy of the London Illustrated News Company. 

MRS. JANET PORTER, FOR 47 YEARS A NURSE 

IN THE ROYAL INFIRMARY, EDINBURGH . 68 

MRS. LAMBERT, AN " OLD STYLE ' NURSE IN THE 

ROYAL INFIRMARY, EDINBURGH . . ,.68 

IN ST. VINCENT'S HOSPITAL .... 96 
CHILDREN'S HOSPITAL, DUBLIN ... 98 
BRIGIT M. KELLY . . . . . . 104 

Matron, Steevens's Hospital, Dublin. 

SISTER MARY ALBEUS ..... 104 

Matron, South Infirmary, Cork. 

MARGARET HUXLEY . . . . .112 

Taken when Matron, Sir Patrick Dun's Hospital, Dublin. 

MRS. KILDARE TREACY . . . . .112 

Late Matron, City of Dublin Nursing Institution. 



Illustrations 



ISABEL HAMPTON ROBB . . . . . i 

Taken when Superintendent of Nurses at the Johns 
Hopkins Hospital. 

M. ADELAIDE NUTTING . . . . .134 

Professor of Nursing and Health, Teachers College. 
Taken when Superintendent of Nurses, Johns Hopkins 
Hospital. 

CHARITY E. COLLINS . . . . .194 

Public School Nurse appointed by the city of Atlanta, Ga. 

JULIETTE SMITH Two-AxE . . . .194 

An Oneida Nurse. 

ANNA C. MAXWELL . . . . .210 

Superintendent of Nurses, Presbyterian Hospital, New 
York City. 

/LILLIAN D. WALD ^ . . . . .216 

Founder of the Nurses' Settlement, New York City. 
Taken during training in the New York Hospital. 

DEACONESS HOSPITAL SISTERS, STOCKHOLM . 238 

A COOKING LESSON IN THE SOPHIAHEMMET . 242 

COUNTRY NURSING IN SWEDEN . . . 242 

IN THE SOPHIAHEMMET ..... 244 

BODIL HELLFACH ...... 260 

Danish Nurses' Association. 

MRS. HENRY TSCHERNING .... 260 

President, Danish Nurses' Association. 

CECILIE LUTKEN ...... 262 

Red Cross Sister and Member of the Board of the Red 
Cross Society, Denmark. 



4 Illustrations 

XIV 

PAGE 

xRs. AMANDA CATANDER .... 268 

MA 

ANNA BROMS ....... 268 

SISTER LINA ... ... 268 

SOPHIE MANNERHEIM ..... 276 

Matron, Surgical Hospital at Helsingfors. 

A NORWEGIAN RED CROSS NURSE . . . 278 
DOCTOR ANNA HAMILTON .... 300 

Founder of the "Florence Nightingale System" in France. 
Reading her Thesis at Montpellier. 

CATHERINE ELSTON . . . . . .310 

Directress of the Tondu Hospital and Nursing School, 
Bordeaux. 

DR. LANDE LECTURING TO THE TONDU NURSES 324 

PROTESTANT HOSPITAL NURSES DRESSING THE 

CHRISTMAS TREE . ... 324 

THE SCHOOL FOR NURSES OF THE ASSISTANCE 

PUBLIQUE OF PARIS ... . 338 

Practical Demonstrations with Mannikin and Bed 
Patient. 



A History of Nursing 



PROPERTY OF THE 
CITY OF NEW YORK 



A HISTORY OF NURSING 



CHAPTER I 

THE STORY OF THE NURSES OF GREAT BRITAIN 

AND IRELAND 

Collaborators: MRS. BEDFORD FENWICK, Miss MARGA- 
RET BREAY, Miss AMY HUGHES; Miss GILL; A 
COMMITTEE OF IRISH MATRONS 

England. Miss Nightingale's demonstration of 
the possibilities of nursing, followed by the success 
of her co-workers and disciples, drew widespread at- 
tention to its possibilities as an opening for woman's 
work, not as a career in the ordinary sense, for of 
material advantage it had none to offer, but as af- 
fording an opportunity for the relief of suffering and 
the service of humanity. This appealed very strongly 
to a group of earnest women of culture, refinement, 
and organising genius, who, from 1870 onwards, 
carried on pioneer labours of the most intensive type. 
We have mentioned Mrs. Wardroper and Mrs. Dacre 
Craven 1 and may now only allude briefly to the im- 
portant upbuilding work of Miss Swift, at the London 
Hospital, where she was succeeded by Miss Eva 

'Vol. II., Chap. vi. 



2 A History of Nursing 

Liickes; Miss Thorold at the Middlesex, Miss Mer- 
ry weather at the Westminster, Miss Catherine J. 
Wood at the Hospital for Sick Children in Great 
Ormond Street, Miss Burt at Guy's, Miss Caroline 
Lloyd at St. John's House, and Sister Amy, of the 
St. John's House Sisterhood, at King's College Hos- 
pital. Some others of the early reformers we shall 
presently meet more closely. 

For none of the pioneers were the conditions under 
which they worked easy ; for some they were excep- 
tionally strenuous. Miss Burt found the reform of 
nursing at Guy's a work of extraordinary difficulty. 
In spite of its urgent need, she received no encourage- 
ment from the medical staff of the hospital, with the 
exception of the late Sir William Gull, who, to his 
honour be it recorded, was alone in giving that sup- 
port which should have been freely extended by the 
whole staff. Miss Rogers, once a Sister at Guy's, 
came in 1910 as the honoured Matron of the Leicester 
Infirmary to address the Guy's Hospital Nurses' 
League and spoke of old times, saying: 'Miss Burt 
was a reformer. She was not popular reformers 
who get people out of their armchairs rarely are ; but 
she fought a good fight, won the victory for you." 
Somewhat happier was the experience of Sister Amy, 
who, at King's College, impressed upon its nursing 
the traditions of discipline, order, and method later 
developed by Miss Katherine Monk, which distinguish 
King's nurses. 

Space forbids us to name others of the many highly 
educated, energetic women who were soon found in 
hospitals and infirmaries all over the country. The 
great, almost magical effect which they produced on 



Great Britain and Ireland 3 

prevailing conditions was the result of personality. 
Of necessity they were forceful and self-reliant, or they 
would not have ventured into such unknown .terri- 
tory, or desired to adopt a calling so widely regarded 
as one suited only for women drawn from the lower 
domestic classes. This was the force which reformed 
nursing, and by which, in a few years, standards 
of care for the sick were evolved such as no amount of 
theoretical instruction alone could have produced. 

To have a clear idea of our subject, we must now 
glance at the provision of the United Kingdom for 
the relief of sickness, and note its dual basis. At the 
time of writing, Great Britain has general and special 
hospitals and general infirmaries supported by volun- 
tary contributions, and Poor Law infirmaries and 
hospitals for infectious diseases maintained out of the 
rates (taxes) , both of which receive patients of much 
the same social class; indeed the latter might be re- 
garded as municipal hospitals and be freely used by 
the public, if the law making a pauper of the sick 
person who enters a Poor Law infirmary for treat- 
ment were repealed. The weakness of the Poor Law 
is that it aims not at the prevention of destitution, 
but at its relief, and so has the effect of creating it, 
for to be entitled to relief it is necessary to prove des- 
titution. The voluntary aid system grew up by its 
side after the dissolution of the monasteries, when the 
kind, unscientific care of the religious orders was re- 
placed by the harsh austerities of the Poor Law. The 
first statute in connection with the Poor Law was 
passed in 1601, in the reign of Queen Elizabeth, and 
provision was made for the relief of aged and impotent 
poor people, coupled with cruel punishments for beg- 



4 A History of Nursing 

gars, which show the spirit of the times. The office 
of Overseer, then established and still, in 191 1 , in exist- 
ence, has never been popular, and, at one time (1783), 
justly fell into disrepute because of the misapplica- 
tion of money raised for the relief of the poor. 

In 1834 an attempt was made to remedy the evils 
arising from maladministration of the workhouses 
by passing the Poor Law Officers' Superannuation 
Act, which was based on the principle that no one 
should be suffered to perish through the want of 
what was necessary for sustaining life. Under this 
act, Poor Law Commissioners were created for Eng- 
land and Wales, who sit as a body and have the 
right to appoint other officers. The administration 
of relief was placed under their control. England 
and Wales were divided into twenty-one districts, 
to each of which an assistant commissioner was ap- 
pointed; Poor Law Unions were formed for visit- 
ing parishes for general administration; Guardians 
elected by the rate (tax) -payers were entrusted with 
the general government and administration of relief, 
and medical relief was arranged for by a contract 
with a medical practitioner, outdoor relief of this 
form being granted. It was not until 1871 that it 
was found expedient to concentrate in one depart- 
ment the supervision of the laws relating to the public 
health, the relief of the poor, and local government, 
and in that year the Local Government Board was 
established by Act of Parliament. 

The provision for the sick in the infirmary wards 
of the monasteries was replaced by the provision of 
wards attached to the workhouses, although at the 
present day in most of the metropolitan, and many 



Great Britain and Ireland 5 

provincial and Scotch and Irish institutions, an in- 
firmary entirely distinct from the workhouse is, and 
always should be, provided. In these the nursing of 
the sick, under the direction of well-trained Matrons, 
approximates to that of a good general hospital with 
a training school. It is, indeed, the advent of the 
well-trained nurse of the better class into these infirm- 
aries which has relegated to the past the iniquitous 
conditions, so ably portrayed by Charles Dickens, in 
the workhouse wards of his day, and has made them 
havens of rest, where the sick poor receive every care 
and attention. What one Poor Law can do, then, 
others can do, and it is to be hoped that the sick wards 
connected with workhouses will, in the near future, 
be abolished, and the sick be gathered together in 
municipal hospitals. 

It is not surprising that the prevailing conditions 
under the Poor Laws the unnecessary harshness with 
which they were administered, and the lack of pro- 
vision for the sick led to the foundation by philan- 
thropists, who had the welfare of the sick at heart, of 
the voluntary hospitals, of which the country is justly 
proud, and which have done a great work for the sick 
poor. If, with the principle of voluntary charity, 
their day is passing, it is not because they have not 
served their day and generation well, but because of 
social evolution. The improvement of the Poor Law 
service, and the high standard of efficiency to which 
the best infirmaries and their nursing service have 
attained, point to the day when the burden of hospital 
maintenance will be distributed between all members 
of the community, instead of being borne by the 
philanthropic few, and that day is brought consider- 



6 A History of Nursing 

ably nearer by the democratic legislation which is 
speedily being enacted in the United Kingdom. 

Again, the apportionment of cases between the 
voluntary hospitals and the Poor Law infirmaries 
depends not mainly on the social or financial position 
of the patient, but upon the needs of medical educa- 
tion. Thus, one patient who presents himself for 
treatment at a hospital may be admitted at once to 
the wards, because the disease or accident from which 
he is suffering is one which lends itself to clinical in- 
struction. Another, equally in need of treatment, 
but of less scientific interest, may be passed on to 
the Poor Law infirmary. The voluntary hospitals 
with medical schools attached are bound to make a 
selection from the numberless patients who present 
themselves, and naturally select those who afford 
the best clinical material. The efficiency of medical 
and nursing education is of the greatest moment to 
the community, but when once the stigma of pauper- 
ism has been removed, as it ought to be, from the 
Poor Law infirmaries, they will inevitably develop 
into municipal hospitals, and it will be recognised 
that the municipalities must make, in each locality, 
sufficient residential hospital provision for its needs, 
where a high standard of medical and nursing care 
is provided, and which, as payment may be made ac- 
cording to the means of the patient, can be freely 
used by all sections of the community. Such hospi- 
tals, with the requisite classification of the sick, 
should become the medical and nursing schools of 
the future, for the efficiency of which the community, 
and not private benevolence, will be responsible. As 
a natural consequence the hospitals will be subject 



Great Britain and Ireland 7 

to public control, while in the case of the voluntary 
hospitals the committees are responsible to no out- 
side authority. 

It has been pointed out in an earlier chapter x that 
the work of reform in the Poor Law infirmaries ad- 
vanced more slowly than in the hospitals under vol- 
untary management, because the difficulties were so 
much greater. Miss Twining's book, Workhouses and 
Pauperism, which should be studied by all who wish 
to be conversant with the history and development 
of Poor Law nursing, quotes a description of the ter- 
rible conditions in the Strand Workhouse in 1855, 
and one may gain a vivid impression of what has been 
done, by comparing that description with the present- 
day sanitary, well-ordered wards of the Central Lon- 
don Sick Asylums, which now make provision for the 
Strand Union patients. Here, under the supervision 
of experienced Matrons and Sisters, nurses and pro- 
bationers in spotless uniforms give intelligent and 
sympathetic attention by day and night, to the sick ; 
a three years' standard of training and examination 
for probationers is enforced, and the certificated 
nurses have organised their own professional leagues 
and have affiliated with the National Council of 
Nurses, through which they are brought into contact 
with the nurses of the world. This is only an example 
of what is taking place in many other Poor Law in- 
firmaries throughout London and the provinces. 
When we realise the progress which has been made 
in the last fifty years there can be no question as to 
evolution in the future. 

The department above the Boards of Guardians 

'Vol. II., Chap. vi. 



8 A History of Nursing 

is the Local Government Board, whose approval 
and sanction are necessary for the appointment 
and dismissal of the higher officials, including 
Matrons of infirmaries and Superintendents of 
nurses. 

On September 29, 1897, there came into force in 
England and Wales the order known as ' ' The Nurs- 
ing in Workhouses Order 1897," promulgated by the 
Local Government Board. The order, which did 
not apply to any infirmary or nursing school under 
an administration separate from the workhouse, was 
the first order affecting nursing that had been issued 
for over fifty years, at which time nursing, as now 
understood, was non-existent. Its importance lay 
in the fact that it definitely abolished nursing by 
paupers, directed the appointment of a Superintend- 
ent Nurse whenever the staff of female nurses in a 
workhouse consists of three or more persons, and speci- 
fied that any Superintendent Nurse appointed after 
the commencement of the order should have received 
three years' training in the wards of a hospital or in- 
firmary. In regard to nurses and assistant nurses, 
they must have had "such practical experience in 
nursing as may render him or her a fit and proper 
person to hold such office." The somewhat vague 
character of this definition gave rise to the proposi- 
tion that a nurse with one year's training should be 
recognised by the Local Government Board as a 
'Qualified Nurse," a proposition which aroused such 
wide-spread protest that it was allowed to drop. 

In 1899, the "Asylum Officers' Superannuation 
Act" became law, conferring the right to pension at 
the age of fifty-five, when twenty years of service 



Great Britain and Ireland 9 

had been completed. A similar bill, introduced in 
1910 and referred to a Select Committee, proposed 
giving the (obligatory and contributory) pension 
after twenty-five years' service, irrespective of age. 
The Committee held that the change should be made, 
so far as women are concerned. It also considered 
the hours of attendants and nurses in asylums ; held 
them to be excessive, and opined that seventy hours 
a week would be enough for day, and sixty for night 
staffs. Up to 1912, no further action on these points 
had been taken. 

A long step forward was taken in January, 1910, 
when the President of the Local Government Board 
appointed three fully-trained and experienced nurses 
to act as inspectors in England of maternity wards, 
nurseries, infirmaries, and the nursing arrangements 
in Poor Law institutions. Miss Ina Stansfeld, who 
had previously acted as Assistant General Inspector 
in London and the Metropolitan District, was ap- 
pointed chief woman inspector, the others being re- 
sponsible to her. The appointment of an inspector 
for Wales quickly followed, and it is hoped that the 
effect of these appointments will be to raise the 
standard of nursing in Poor Law infirmaries, and con- 
sequently the comfort of the sick both in these in- 
firmaries and in workhouse wards, which, so far, in 
many instances, have not kept touch with modern 
progress. 

NURSING EDUCATION 

The progress of nursing education, on efficient 
lines, has been retarded by the fact that training 
schools are not controlled by educationalists, but 



io A History of Nursing 

by the Committees of Management of the hospitals, 
who are primarily appointed or elected for their 
ability to give, or obtain, and administer, the funds 
necessary for the maintenance of the hospital. The 
average member of a hospital committee has not 
the special knowledge enabling him to deal effici- 
ently with nursing education. Even the Council 
of the Nightingale Fund at St. Thomas's is com- 
posed entirely of men no trained nurse has a seat 
upon it and the same applies to other hospitals 
having so-called nursing committees. The reason 
why the professional education of trained nurses has 
been, and continues to be, defective, is because the 
philanthropists and financiers who control the vol- 
untary hospitals have, with very few exceptions, 
determinedly excluded the educational and profes- 
sional element. 

In regard to the medical schools connected with 
hospitals, this difficulty is non-existent. Medical 
education is controlled by the General Medical 
Council, a body composed entirely of registered medi- 
cal practitioners, and the education of students in 
the medical schools is organised under the direct 
control of the Dean of the school, and a Medical 
Board, in conformity with the requirements of the 
above Council. The hospital has no voice in the or- 
ganisation of its curriculum, although the medical 
school is so essential to its efficiency and even its 
existence that many committees spend large sums of 
money on college buildings, pathological blocks, and 
other departments in order to attract students to 
the hospital. If the nursing schools connected with 
hospitals were similarly organised by a Council of 



Great Britain and Ireland n 

Trained Nurses, whose primary duty was the effici- 
ency of the school and its pupils, Matrons would not 
have to plead long before obtaining necessary in- 
struction and facilities for the nursing staff, and 
adequate homes for them to live in; nor would the 
nurses, through their professional societies, have to 
arrange and pay for lectures on such subjects as 
elementary bacteriology, in order to obtain know- 
ledge without which, at the present day, they cannot 
properly perform their duties, because hospital com- 
mittees have failed to supply this instruction. The 
presence of a body within the hospital which would 
intelligently direct the studies of the pupils, and of 
an outside professional controlling authority, would 
have the same stimulating and wholesome effect 
upon nursing education as has resulted from the pro- 
fessional organisation of medical education. While, 
therefore, in connection with the voluntary hospitals, 
the work of organising thorough, systematic educa- 
tion for nurses has, in some instances, reached a high 
level of practical efficiency, its completeness has un- 
doubtedly been retarded for the above reasons ; and 
in institutions which do not possess the necessary 
facilities for training, and which in establishing a 
training school are chiefly interested in obtaining 
cheap labour for the nursing of their patients, the 
certificated pupils are very indifferently equipped for 
their future work. Especially now that there is 
greater classification of patients, and many cases 
formerly admitted to general are now sent to special 
hospitals, the need of some plan of affiliation for 
training purposes is becoming increasingly urgent. 
In regard to preliminary nursing education only 



12 A History of Nursing 

a few hospitals have organised courses, although 
wherever this has been undertaken, the benefit of 
the course is manifest. In London such courses have 
been established at the London, Guy's, and St. 
Thomas's ; in the provinces, at the Leicester Infirmary, 
and the Royal Infirmary, Bristol ; in Scotland, at the 
Royal Infirmary, Glasgow, and in Ireland, through 
the Metropolitan Technical Training School for 
Nurses, in Dublin. There is a difficulty also, in any 
but the largest hospitals, of forming classes sufficiently 
large to warrant the appointment of special teachers, 
and, in the future, it is probable that such preliminary 
training will have to be centralised before it can be 
organised on a comprehensive plan. Nor, at the 
time we write, are facilities yet afforded to nurses 
for post-graduate courses, so that they may return 
to hospital for a time and become acquainted with 
the newest treatment and methods. This again 
needs the stimulus which a central supervising au- 
thority would supply. 

Nursing standards have developed and extended 
to meet the requirements of medical science. When 
Miss Nightingale first laid down those laws which 
must always be fundamental, a year's practical and 
technical training was the period defined, but a 
further term of service was exacted, so that although 
the term of actual training may have been short, 
further practical experience was considered neces- 
sary. Two points must also be borne in mind in 
connection with this period: first, that the demands 
made upon trained nurses were neither so exacting 
nor so extensive as at the present time ; secondly, that 
the Nightingale probationers were specially selected 



Great Britain and Ireland 13 

women, of a higher educational status than the 
ordinary nurses, and the curriculum prescribed for 
them was arranged wholly with the object of prepar- 
ing them for positions of responsibility in institutions. 

A temporary feature was the "lady pupil' who 
had special privileges. That system has now fallen 
into almost complete disuse, and in every hospital 
of standing (except the London) a three-years' cer- 
tificate is essential (1912) for promotion to the higher 
posts. 

As illustrative of a preliminary nursing school, 
a three-years' course, and a paying probationers' 
course we may follow in brief outline the regulations 
of Guy's hospital training. The preliminary course 
of six weeks must be satisfactorily passed by all pro- 
bationers, though they may at the discretion of the 
Matron be dropped at any time. The probationer 
pays six guineas for this training, a due proportion 
of the fee being returned to her if she is not retained, 
but no special certificate is given for it. The course 
comprises tuition and practical work in elementary 
anatomy, physiology, hygiene, dispensing, bandag- 
ing, the making of dressings, use of instruments, bed- 
making, housework, sick-room cookery, etc. For 
the regular three-years' course the probationer must 
be between twenty-three and thirty-two years of 
age and of good physique. Her training is in medical 
and surgical nursing and she must pass a ward pro- 
bation of not more than three months. She is paid 
a yearly allowance and is supplied with a certain 
amount of indoor uniform, full outdoor uniform, and 
laundry. During the first year she attends classes 
conducted by the Sisters, and lectures given by the 



14 A History of Nursing 

staff on nursing, and on medicine and surgery as 
applied to nursing. In the second year come classes 
for instruction in pharmacy and dispensing, given 
by the hospital pharmacist, and examinations follow 
in nursing, medicine, surgery, and dispensing. Fail- 
ure to pass in any one subject will cause her to be 
dropped, unless, by special permission of the Matron 
(presumably for practical efficiency) , she is reinstated. 
The one-year paying probationer may be between 
the ages of twenty-three and forty, and is trained 
in medical and surgical nursing. She attends all 
classes and lectures, paying a special fee for this, 
besides the fee for board and lodging. She is not 
placed on night duty, and has special quarters. 
While she must agree to remain for the full year, the 
Matron may terminate her course at any time with 
the sanction of the Treasurer and Superintendent, 
if she is not adapted for training. 

After training is complete, the hospital offers per- 
manent positions to staff nurses as well as Sisters. 
Salaries are paid, and the hospital takes out a pension 
for each nurse in the Royal National Pension Fund, 
while she herself takes a similar but smaller policy. 
At fifty the Sister or nurse retires, unless by a special 
resolution of the Governors she is retained for not 
more than five years' longer active period of service. 
Many three-years' pupils at Guy's also gain, during 
their course, the certificate of the Central Mid wives' 
Board, or of the Incorporated Society of Trained 
Masseuses. Although there is no post-graduate 
course, yet facilities are informally granted, on ap- 
plication to the Matron by those holding the hospital 
certificate, for returning for a few weeks to study up 



Great Britain and Ireland 15 

on new methods. A course of three months' instruc- 
tion in administrative work has also been developed, 
not limited to Guy's nurses alone. Candidates are 
eligible if trained for three years in a general hospital 
of not less than two hundred beds, and after having 
experience as Ward Sister. They are accepted on 
the judgment of the Matron, and pay a fee for their 
course, which comprises: hospital and nurses' home 
housekeeping; management of kitchen and stores; 
ordering and receiving milk, meat, etc., from trades- 
men ; management of servants and their work ; cook- 
ing and serving of diets to patients and staff ; laundry 
work; management of linen stores, including stock- 
taking; book-keeping, and the management of the 
Matron's Office, including the engagement of servants 
and the acceptance of probationers. 

When a nurse has gained her certificate, her con- 
tract with her training school usually ceases, and she 
is free to take up whatever work is most congenial 
to her, though some hospitals still exact a fourth 
year of ward service, in return, it is alleged, for the 
training given, the fact being overlooked that, if 
pupils in training were not utilised to do a great deal 
of ward work, greatly increased expense would be 
incurred for domestic service. 

The fully- trained nurse has no means of registering 
her newly-gained qualifications, nor is there any pro- 
fessional body to which she can look for guidance, 
advice, or control. She joins the chaotic ranks of 
the trained, semi-trained, and untrained workers all 
struggling for employment, in which the assurance of 
ignorance often seems to carry as much weight as the 
knowledge which ensures the safety of the patient. 



16 A History of Nursing 

This is, no doubt, the reason which chiefly influences 
so many nurses in England to remain in institu- 
tions; such work is hard, salaries small, and prizes 
in the way of well-paid posts few, but it is regular and 
highly responsible work, and the nurse's professional 
position is recognised and respected. 

In many hospitals the position of the Matron is 
most congenial. She is, and always should be, di- 
rectly responsible to the Committee of Management 
for the efficiency of both the nursing and domestic 
departments, in the same way that the Medical 
Board and the Secretary report directly on their own 
departments. The committee thus holds the bal- 
ance of power. Her relations with the two other 
departments are, as a rule, cordial. The oversight 
of nursing and the training of pupils are both of great 
interest, and her association with patients, nurses 
and staff, and the many people with whom, in the 
course of her work, she is brought into contact, com- 
bine to make the life of a Matron full of human 
interest and satisfying occupation. Added to this, 
for those Matrons who realise that they have a duty 
to their profession as a whole, as well as to the hos- 
pitals which they serve, there is a certain amount 
of public work to claim interest and support. The 
position of a Matron has both dignity and charm, 
and the solitariness which was somewhat oppressive 
when the Matrons lived in "splendid isolation" and 
scarcely knew their colleagues in other hospitals in 
the same locality, is now counteracted by the friendly 
feeling and intercourse developed through professional 
associations. 

If the nurse desires to seek her vocation in the 




Gertrude Rogers 
Matron, Leicester Infirmary 




Beatrice Cutler 

Assistant Matron. St. Bartholomew's Hospital, London 
Hon. Secretary, National Council of Trained Nurses of Great Britain and 



Great Britain and Ireland 17 

larger world outside the hospital, there is a variety 
of choice for her : first let us mention district nursing, 
as Great Britain stands first in the perfect organ- 
isation of the Queen Victoria's Jubilee Institute. 
Our nurse, holding her three-years' certificate, is 
now required to take a further six-months' training 
in district nursing, including the study of hygiene 
and instruction in sanitary matters. At the end of 
this time, if she passes a satisfactory examination, 
her name is placed on the Roll of Queen's Nurses. 
Because of the importance of this association we shall 
presently give it some detailed consideration. 

Private duty is a branch of work which absorbs 
many nurses, and in none is the present disorganisa- 
tion in their ranks felt more acutely ; in none are the 
economic conditions more unjust. In the private 
nursing world we find both the most highly trained 
and experienced nurses working on the co-operative 
system in connection with their own professional 
societies, and also those working on the private 
nursing staff of hospitals, which regard them as a 
legitimate and fruitful source of income. x The system 
of undergraduate private duty is not only unfair to 
the self-supporting nurse who has spent three years 
in preparation for her work, but is also most unjust 
to the pupil, whose best year in the hospital is sac- 
rificed and who thus loses the most valuable part 
of her training. 

The private nurse is also exposed to the competi- 
tion of the hospital failures, the semi-trained, the 
untrained, and a dark substratum of the criminal 
class, who find, in the confidential relations in which 

1 See Official Reports, The London Hospital, as example. 
VOL. in. 2 



1 8 A History of Nursing 

the nurse is admitted to the household, an excellent 
opportunity to practise their nefarious business. It 
is undeniable that the confidence of the public in 
private nurses as a class has been shaken by the 
conduct of women who assume the uniform for crim- 
inal purposes. Well- trained and reputable women 
who render services of the very highest value to the 
public are entitled to the protection and professional 
recognition which can only be secured to them by the 
publication of a State Register of Trained Nurses. 

NURSES IN GOVERNMENT SERVICE 

That nurses are indispensable to the community 
is shown by the fact that most Government offices, 
directly or indirectly, find it necessary to utilise their 
services, and amongst the openings offering a career 
are: 

Queen Alexandra's Royal Naval Nursing Service, 
under the Admiralty. Here, in addition to her 
thorough three-years' training in a civil hospital of 
the United Kingdom, the candidate must possess 
administrative capacity and power to impart know- 
ledge to others, for her duties will include part of the 
training of the male nurses. There are three grades : 
nursing, superintending, and head Sisters. All the 
Sisters rank as officers, and pensions are granted after 
ten years' service, or earlier if incapacitated for duty. 
In 1900, a Nursing Reserve was formed for this serv- 
ice, the Admiralty "relying on the Matrons, with 
the sanction of their committees, to select such suit- 
able nurses as they can arrange to spare" in time of 
war. 



Great Britain and Ireland 19 

Queen Alexandra's Imperial Military Nursing 
Service. This, formerly the Army Nursing Service, 
was reconstituted in 1902, under a Nursing Board 
on which the Matrons of two civil hospitals have 
seats, as well as the Matron-in- Chief of the Service. 
The grades are: staff nurse, Sister, Matron, Principal 
Matron, and Matron-in-Chief. Candidates are to 
be between twenty-five and thirty-five years of age, 
holding the usual three-years' certificate. Unfor- 
tunately the wording of this clause makes such 
a certificate not absolutely compulsory. The Ma- 
tron-in-Chief must satisfy the nursing board that 
as regards education, character, and social status 
the candidate is a fit person to be admitted to the 
service, and, before Sisters are promoted to the posi- 
tion of Matron, they are required to pass an exam- 
ination and give practical evidence of knowledge of 
administrative work and teaching ability. Pensions 
are granted after twenty years' service, or at the age 
of fifty years. 

Queen Alexandra's Imperial Military Nursing Re- 
serve.- -This reserve is formed for the purpose of 
supplementing the regular service in the event of 
war. Candidates must be between twenty-six and 
forty-five years of age, and possess a certificate of 
not less than three years' training and service in a 
civil general hospital, or Poor Law infirmary recog- 
nised by the Local Government Board as a Nurse 
Training School. They must agree to serve either 
at home or abroad as required, if called in time of war, 
and are enrolled for a renewable period of three years, 
though their continuance in the service is at all times 
subject to review by the Nursing Board at the end 



20 A History of Nursing 

of each year's service. Once a year they must report 
to the Matron-in-Chief in her office, and show that 
they are continuously employed in bona-fide nursing 
duties. The staff consists of staff nurse, Sister, 
and Matron. 

The Territorial Force Nursing Service. This serv- 
ice is for the purpose of maintaining a staff of nurses 
ready to serve in general hospitals in the event of the 
embodiment of the forces for home defence. The 
requirements are similar to those already mentioned. 
There is an Advisory Council of which the duty is to 
frame rules and make recommendations such as will 
provide for a similar system of control in each hospital. 
Local committees are appointed in each hospital 
centre to enrol nurses and revise the rolls annually. 
In time of peace the executive officer of each hospital 
is the Principal Matron. For active service the staff 
is graded into staff nurses, Sisters, and Matrons, and 
double appointments are made for each, so that in 
case one is unable to serve the other may be ready. 
The full nursing strength of each hospital is 120, 
of whom 91 will be actually needed. 

Another branch of work in connection with the 
nursing department at the War Office is the nursing 
of the Military Families' Hospitals in the chief depots 
or garrisons. Here there are nurses and head nurses, 
who, besides the usual certificate, must be certified 
midwives. 

Queen Alexandra's Military Nursing Service for 
India. This service, which was distinguished by the 
tone set for it by its first and eminently capable Lady 
Superintendent, Miss C. G. Loch, R.R.C., a St. 
Bartholomew's Sister, comprises Nursing Sisters, 



Great Britain and Ireland 21 

Senior Nursing Sisters, and Lady Superintendents. 
The nursing board at the India Office requires evi- 
dence of three years' training in a general hospital. 

Colonial Nursing Association. The Colonial Office 
engages nurses for service in Crown colonies, through 
the association founded by Lady Piggott. The 
nurses work both in hospitals and in private houses. 
The certificate of the Central Midwives' Board is 
required in addition to one of general training. 

When we turn to the civil government we find that 
nurses are at work under the Local Government 
Board in Poor Law infirmaries and in the hospitals 
of the Metropolitan Asylums' Board, which receive 
infectious cases needing hospital treatment in the 
metropolitan area; under the Board of Education 
there are school nurses ; under the Home Office they 
are engaged in asylums for the insane, and in prisons. 
In the metropolitan area both school nurses and 
asylum nurses are under the London County Council. 
The Foreign Office engages a certain number of 
nurses for service in British protectorates. 

Nurses also find scope for their professional gifts 
as health visitors, sanitary inspectors, as lecturers 
on nursing, and in connection with creches; then, 
in increasing numbers they are being attracted to 
the work of foreign missions, a field in which they 
find abundant opportunities for the exercise of all 
the talents they may possess. 

MENTAL NURSING 

This branch of nursing is conducted chiefly in 
private or public asylums. Those taking it up enter 



22 A History of Nursin 



cr 



as a rule, an asylum for training, where they sign a 
contract for three years. At the end of this time it 
is the aim of the more progressive to obtain the cer- 
tificate conferred by the Medico-Psychological As- 
sociation, which has instituted a uniform examination 
for mental nurses, both men and women, throughout 
the country. A very limited number of nurses take 
the double training in both general and mental 
nursing, and those who do so are rewarded by the 
enlarged powers and skill which they attain. 

Trained nurses are also entering largely into the 
anti-tuberculosis campaign, and are becoming in- 
creasingly interested in the possibilities which lie 
before them as trained workers in social service in 
connection with moral prophylaxis. The need of 
instruction upon venereal diseases in the course of 
their training is now realised. Hitherto teachers in 
nursing schools have been almost silent upon this 
subject, yet nurses, when thoroughly alive to their 
opportunities, should be a powerful force in helping 
to combat these social plagues and teach moral hy- 
giene. In planning the programme for the Interna- 
tional Congress of Nurses in 1909, the British leaders 
gave this subject a prominent place, and the British 
Journal of Nursing has conducted a campaign of 
enlightenment concerning it. 

QUEEN VICTORIA'S JUBILEE INSTITUTE FOR NURSES 

We have already mentioned the beginnings of dis- 
trict nursing, I and for complete historical details refer 
our readers to the Reports and Proceedings of the 

'Vol. II., Chap. vi. 




y. 
"rj 

u 
O 

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Great Britain and Ireland 23 

Jubilee Congress for District Nursing, which was 
held in Liverpool in 1909 to celebrate fifty years of 
district-nursing work. They should also read Miss 
Nightingale's letter to the London Times of April 
14, 1876, written to get funds for the Central Home 
of the Metropolitan National Nursing Association, 
now at 23 Bloomsbury Square. From this centre, 
district nursing spread rapidly through London and 
the provinces. In Scotland, the pioneer of such work 
was Mrs. Mary Orrell Higginbothan, who founded 
the Glasgow Sick Poor and Private Nursing Asso- 
ciation in 1875. 

The gracious act of her Majesty Queen Victoria, 
in devoting 70,000 of the Women's Jubilee Offer- 
ing to the furtherance of district nursing, in the 
year 1887, gave the mainstay from which has 
branched a great national, articulated organisation. 
The provisional committee appointed to help ad- 
minister the offering (among whom was a nurse, Mrs. 
Dacre Craven) decided to apply the interest accruing 
from it to found the Queen Victoria's Jubilee Institute 
for Nurses, both to prepare nurses for work with the 
sick poor in their own homes, and to extend branches 
throughout the United Kingdom. The Metropolitan 
and National Nursing Association was adopted by 
the Institute as its London nucleus, and the majority 
of then existing associations, including the pioneer 
societies in Liverpool, Glasgow, and other cities, 
agreed to the condition of affiliation with the Insti- 
tute. The Royal Charter of 1889 connected the 
Institute with the ancient foundation of St. Kather- 
ine's Royal Hospital, 1 and the offices were within 

1 See Vol. I., p. 452. 



24 A History of Nursing 

its precincts until 1903, when with the need of larger 
quarters they were moved to 58 Victoria Street, S.W. 
In the year following, the official connection with St. 
Katherine's terminated, and Queen Alexandra be- 
came patron of the Institute. It is governed by a 
Council mainly representative, on which Scotland, 
Ireland, and Wales have direct representation. 
Scotland has, as well, its own executive committee. 

In 1903 Lady Dudley established a fund for pro- 
viding district nurses in the poorest parts of Ireland, 
by means of which Queen's nurses are maintained 
in the extreme west and other districts where it is 
impossible to raise funds. With this are joined two 
other societies, the Homestead and Manchester West 
of Ireland Fund. The Women's National Health 
Society for Ireland, inaugurated in 1908 by the 
Countess of Aberdeen, is affiliated with the Institute, 
and Queen's nurses are taking an active part in the 
work of this society, especially in the prevention of 
infant mortality and tuberculosis. 

Wales has its pioneer central home in Cardiff, and 
Welsh-speaking nurses are necessary for rural dis- 
tricts, especially in North Wales. The North and 
South Wales Associations were formed in 1909 to sup- 
ply district nurses, and more especially certified mid- 
wives, throughout the principality. Each has a 
central committee and co-operates with education 
committees and other county and city officials. To 
the energy of these new associations has been largely 
due an aroused public interest in district nursing, 
which has greatly increased the number of societies 
and nurses. 

The standards for the Queen's nurses are excellent, 



Great Britain and Ireland 25 

and should be imposed on all district nurses doing 
similar work. Unfortunately, side by side with this 
system has grown up another of employing women 
who are certified mid wives, and have had a short 
training in general nursing, not necessarily in a hos- 
pitalfor work in the homes of the poor as "village 
nurses," under county nursing associations, or as 
"cottage nurses" (general help, who live in the cot- 
tages with their patients) under what is known as 
the Holt-Ockley system. Thus, after fifty years, 
Florence Nightingale's minimum standard of one 
year in a hospital has been reduced, for the nurses 
of the poor, to a few months, with disastrous results, 
as the presence of the cheap nurse makes it increas- 
ingly difficult to raise the salary for a thoroughly 
efficient Queen's nurse. 

The Queen's Institute, making the best of things 
as they are, recognises the county nursing associa- 
tions, as told in the following extract: 

From the beginning of this movement the Queen's 
Institute has realised the importance of nurses employed 
in country work holding a certificate of midwifery, and 
also that special supervision is essential. Wherever 
possible, nurses with full hospital, district, and midwifery 
training, in other words Queen's nurses, are employed 
in country associations affiliated with the Institute. For 
areas where neither work nor funds permit the support 
of such nurses, the county associations undertake to 
train women as midwives, giving them additional in- 
struction in elementary sick nursing, and these "village 
nurses" are supplied to rural districts. The Queen's 
Institute requires the appointment of a Queen's nurse 
as county superintendent, who is responsible to the 



26 A History of Nursing 

county committee for the adequate and constant super- 
vision of the practical work of these nurses. 

There are some thirty- two county associations, of 
which eighteen are affiliated with the Institute. * 

The village nurses' preparation for general nursing 
is thus simply a "short course," given them, usually, 
in the Maternity, Charity, and District Nurses' Home 
in Plaistow, which was opened in 1889, under Miss 
Katharine Twining, and is now, with its branches, 
the principal training school for the county asso- 
ciation's candidates. Call them what one will, the 
cottage nurses are not nurses. They may be useful 
household help, and as such are badly needed in 
cottage homes, but no lasting good comes from the ac- 
ceptance of inferior professional service for the poor. 
They, more than any others, need the best. Nor is 
that even a genuine charity which compels the worker 
to give the charity. The cottage nurses are miser- 
ably underpaid and themselves cling to the very 
poverty-line. Helpless to help themselves, they but 
drag lower the workers just above them. In making 
use of them, the Queen's Institute is conscientiously 
doing what seems to its officers the best possible under 
the circumstances, but as an impartial historian we 
can but hold the "village nurse" to be a professional 
and economic mistake. England has some thirty- 
five county associations, of which, in 1911, twenty- 
two were affiliated with the Queen's Institute. The 
lines upon which they work are similar throughout, 
and the influence of the Institute is to place women 

1 Report and Proceedings, Jubilee Congress District Nursing, 
Liverpool, 1909. 



Great Britain and Ireland 27 

" with full hospital training whenever possible, but in 
every case with some knowledge of simple general 
nursing, for scattered rural districts." 

Two recent Acts of Parliament have touched 
nurses closely : the Mid wives' Act of 1902 (for England 
and Wales) has made it increasingly imperative that 
district nurses should hold the certificate of the 
Central Midwives' Board, and the Notification of 
Births Act of 1907 has led to their employment in 
larger numbers, by municipal councils, as visitors 
to the cases thus notifiable. In many associa- 
tions, too, nurses take an active part in the work 
of maternity clubs, schools for mothers and "Bab- 
ies' Welcomes." 

Public-school nursing grew from district-nursing 
work as a branch from a tree. Its origin dates from 
1891-92, when during the inquiry into the feeding 
of school children it was found that children suffered 
much from neglected minor ailments and also that 
much school time was lost as a result of infectious 
troubles. One of the managers of a school in the 
Drury Lane District, under the London School 
Board, then applied to the Metropolitan Nursing 
Association for a nurse to visit the children during 
school hours. The first nurse so detailed was Miss 
Amy Hughes (who later attained the highest post un- 
der the Queen's Nurses' Institute) and so conspicuous 
were her successful results that, as has been often 
related, other associations followed the example: the 
London School Nurses' Society was formed in 1898, 
and in 1904 the London County Council appointed 
a staff of nurses under a superintending nurse, 
stimulated thereto by Miss Honnor Morten, one of 



28 A History of Nursing 

the School Board, who had taken the year's training 
of a lady probationer in the London Hospital. The 
appointment of Miss Helen L. Pearse as Super- 
intendent of School Nurses in 1908 placed at the 
head of the work a woman of abounding energy 
and intelligence, whose wide view and warm social 
sympathies inspired it with a truly vital force. 
The school nurses now have their own League. 

Under the Education Act of 1907, the authorities 
must provide medical inspection of school children, 
and may provide nursing. The sympathetic attitude 
of the Board of Education toward the school nurse 
has had the result of creating a growing army for the 
care of the children, the usual mode of recruitment 
being by agreement with district nursing associations, 
the education authorities paying sums proportioned 
to the work they require. 

Under the Children's Act (1908), the London 
County Council and Boards of Guardians elsewhere 
are entitled to pay for the services of nurses as Infant 
Life Protection Visitors for Boarded-Out Children. 
Queen's nurses are being thus employed extensively 
in both England and Wales, as their knowledge of 
the people of their districts and their tactfulness in 
dealing with the problems of the home enable them 
to give accurate reports both as to the children and 
their surroundings. In all these new lines the nurse's 
opportunities for educating the community to higher 
standards of living are endless. 

The value of the trained district nurse's services in 
the crusade against tuberculosis need not be insisted 
upon. Associations are alive to the need of the 
nurse's educational and preventive work and to the 



Great Britain and Ireland 29 

importance of her observation and her lessons in 
practical sanitation and hygiene. 

Under the auspices of the Red Cross Society, 
Queen's nurses are giving lectures on home nursing 
in different parts of England and Wales, their practi- 
cal experience in making the best use of the equip- 
ment found in the ordinary home fitting them to 
instruct others ably on such lines. 

A rapidly increasing number of associations are 
framed on the "provident" or "clubs" system, every 
one desiring the services of the nurse contributing on 
a sliding scale as arranged by the local committee. In 
many industrial centres the people themselves raise 
the needed funds and entirely control the association. 
Midwifery and maternity clubs are also springing up 
in every direction. The whole trend of public opin- 
ion is toward encouraging self-respect and independ- 
ence amongst those to whom the nurse ministers. 
At the same time the interests of those who are un- 
equal to the struggle of life are safeguarded, and no 
case is refused nursing because of poverty. Provi- 
sion is also made for those who are not poor, yet could 
ill afford the fees of the private nurse. Many 
associations have a ''daily visiting nurse," who 
attends such patients at a fixed scale of fees. 

The most striking feature in the development of 
district nursing is the prominence of its educational 
side. Almost imperceptibly, yet none the less stead- 
ily, has this change progressed. As the value of the 
nurse's teaching in the homes rises, it becomes more 
important that she herself should be especially pre- 
pared and acquire some insight into those social 
questions which affect the general welfare of the com- 



30 A History of Nursing 

munity. District nursing has found an interpreter 
in Miss M. Loane, whose writings, The Queen's Poor 
and other books, are widely known. 

Many nurses qualify for the practice of midwifery, 
to which we can only briefly refer. We know that as 
far back as 1863 Miss Nightingale desired to train 
women for this service and had prompted the un- 
successful experiment at King's College Hospital. 1 
In 1872, the London Obstetrical Society instituted 
an examination which, though elementary, was 
a first step toward raising standards. In 1881, 
the Midwives Institute was founded to raise the 
status and efficiency of midwives and to petition 
Parliament for their recognition. In 1891, the first 
attempt was made toward legislation, and in 1902 
Parliament passed the Midwives Act. The two most 
prominent and able workers for this reform 2 were 
Miss Jane Wilson and Miss Rosalind Paget. 

THE STRUGGLE FOR ORGANISATION 

We now turn back to trace the movement for self- 
organisation and economic emancipation in which 
the nurses of Great Britain led the way. We have 
followed the path through long centuries when the 
religious Sisterhood set the pattern of nursing; we 
have seen the ebb and flow of religious societies aim- 
ing at freer forms and have found the culmination of 
time's changes in Miss Nightingale's creation of a 
secular profession of women trained to nurse. But 

1 Vol. II., p. 238. 

2 For detailed information one should apply to the Midwives 
Institute, 12 Buckingham St., Strand, London. 



Great Britain and Ireland 31 

Miss Nightingale's work, magnificent as it was, did 
not include the inspiring idea of self-government in 
mutual, voluntary, democratic union. This was to 
be the service and the contribution of her success- 
ors, who, in turn, had to struggle desperately, and 
submit to contumely and abuse for the sake of their 
ideals. 

Within twenty years after the opening of St. 
Thomas's, it was clear that the first need of the young 
profession was a leader who could form a strong as- 
sociation of its members, through which the isolated 
units could be brought together, their views on pro- 
fessional questions voiced, their economic independ- 
ence safeguarded, and some uniformity of education 
and practical standards established. Nor did the 
leader delay; indeed, she had been among the first 
to feel the need, which her own advanced work in 
hospital had helped to accent. We meet a remark- 
able personality in Ethel Gordon Manson, who, later, 
as Dr. Bedford Fenwick's wife, maintained a dynamic 
relation to the nursing movement of the whole world 
and held electric keys of power, by which she admin- 
istered stimuli in every direction. In an interesting 
character sketch, to which our readers are referred, * 
the foremost features of her complex and versatile 
character, "courage and idealism, British grit and 
dogged tenacity of purpose," combined with extra- 
ordinary elasticity of spirit, are recorded, but we 
would add that courage is too moderate a word for 
her intrepid daring in facing difficulty, and that her 
loyalty to her ideals has been evidenced by twenty- 

1 Ethel Gordon Fen-wick : A Character Sketch by an Intimate, 
A. J. N., Sept., 1901, p. 861. 



32 A History of Nursing 

five years of the most nerve-wearing battle and un- 
remitting labours, freely chosen in place of a life of 
brilliant ease and enjoyment. From our modern 
point of view, her contribution to the nursing 
movement has been as important as Miss Night- 
ingale's. 

At twenty-four, Miss Manson, having begun her 
training at twenty-one, became Matron of St. Bar- 
tholomew's Hospital, and with her appointment a 
new chapter in English nursing began. During six 
years she was a path-finder, organising the school on 
the admirable lines it has since followed, and earning 
a reputation for clear judgment, unerring intuition, 
professional enthusiasm, great organising ability, 
tenacity of will, and public spirit. It was she who 
broke the ground for the democratic system of a 
higher, universal development of nursing education. 
In 1887, she married Dr. Bedford Fen wick, and, with 
his active co-operation (for never have nurses and 
their causes had a more loyal, unselfish friend than 
Dr. Fenwick, whose brotherly deeds have been so self- 
effacingly done that they will never be fully known), 
devoted herself to the advancement of her profession 
and dedicated to it all her unusual gifts and energies. 
In the year of her marriage she proposed the form- 
ation of an Association of Trained Nurses, not limited 
to those of one school. Coming from her, the propo- 
sition commanded widespread attention and respect. 
It also aroused intense hostility, for those who, for 
economic or autocratic reasons, desired to keep nurses 
unorganised and in subjection, knew that their cham- 
pion would be a formidable opponent. Undaunted, 
Mrs. Fenwick called together on November 21, 1887, 



Great Britain and Ireland 33 

a group of kindred spirits at her house in Upper 
Wimpole Street (a house where many historic meet- 
ings relating to nursing organisation have since been 
held), and in December the British Nurses Associa- 
tion was formed. Said she in this connection: 
"The Nurse question is the Woman question, pure 
and simple. We have to run the gauntlet of those 
historic rotten eggs." 

Thenceforth the hospital world of England was 
divided into two camps. The progressives had as 
their goal the organisation of nurses through a central 
governing body appointed by the State, by which 
educational standards could be established, the 
skilled differentiated from the unskilled, and disci- 
pline maintained : the reactionaries w T ould not admit 
the necessity for fixing a minimum standard of train- 
ing and were strongly averse to organisation amongst 
nurses. Their stronghold was then, as afterwards, 
an obstinate refusal to recognise the question as an 
educational one, and an immovable persistence in 
treating the registration of nurses as a sort of intel- 
ligence office for superior domestic help. 

Besides the hospitals which profited by fees for 
nurses, enterprising middlemen made large incomes 
by the simple process of engaging trained or half- 
trained nurses at small salaries, supplying them to 
the public at full fees and pocketing the difference. 
Naturally such persons regarded the proposition for 
State Registration of Nurses with alarm. In many 
ways nurses were an asset to mercenary individuals. 

If it be asked why intelligent women should have 
permitted others to exploit them, the answer may be 
given in one word, non-organisation. The position 

VOL. Ill 3 



34 A History of Nursing 

thus came, at last, to be much more complex than at 
first appeared when British nurses put forth their 
plea for simple justice to the sick that they should 
no longer be at the mercy of unskilled and unscru- 
pulous women who, donning the nurse's uniform, 
preyed upon the public with impunity, since legal 
evidence of efficiency could not be demanded of them 
-and justice to trained nurses, by providing that 
those who had undergone and benefited by an ar- 
duous and lengthy training should be distinguished 
from those who had not taken the pains to equip 
themselves thoroughly before undertaking the respon- 
sible duties of practising as trained nurses a neces- 
sary differentiation between skilled and unskilled 
well understood by members of men's professions 
and trades, and vitally important in the case of a 
profession on whose skill, or the lack of it, the balance 
between life and death may depend. Little by little 
the scene shifted until it was clear that Mrs. Fen wick 
had taken up arms against an arrogant monopoly. 
For twenty-three years the battle was waged, and 
is not yet ended. During this whole time she has 
not only led without faltering, but has performed 
incessant drudgery as well, meeting abuse and mis- 
representation by the way. 

In 1893, to have a means of expression, she assumed 
the control and editorship of a small weekly paper 
called The Nursing Record, which had taken the pro- 
gressive side from the outset. In 1902, she enlarged 
the magazine and called it The British Journal of 
Nursing. It rapidly came to be the foremost nurs- 
ing journal of the world and is the most complete 
record in existence of nursing affairs and progress in 



Great Britain and Ireland 35 

all countries. Fearless, aggressive, and of a consist- 
ent, unwavering policy, it has been the advance 
guard of nursing interests all along the line. For 
many years Mrs. Fenwick has had associated with 
her on the Journal Miss Margaret Breay, well known 
as one of the hardest workers in a hard-working pro- 
fession. What words can measure the depths of 
Miss Breay's staunch loyalty to ideals and to friends? 
None. But her numberless services are appreciated 
around the world. 

The progressives rallied with enthusiasm around 
the British Nurses' Association, and within twelve 
months it numbered a thousand well- trained nurses, 
possessed of a splendid buoyant professional spirit, 
and well aware of the need of action. Chief among 
the opposition were Mr. now Sir Henry Burdett, 
editor of The Hospital, and Miss Liickes, Matron 
of the London Hospital, an institution w r hich has 
never ceased to exert its whole power against 
the new spirit. Opposed, too, were many of 
the authorities of the metropolitan hospitals to 
which medical schools were attached. They ob- 
jected to State interference with their absolute 
authority, deemed organisation among nurses to 
savour of 'trades unionism," and regarded it 
with the same disfavour that, in the past, em- 
ployers had shown toward co-operation amongst 
workers in the industrial world. Because the 
struggle that followed is full of lessons, and because 
of its historic importance, dividing, as it did, pass- 
ing from oncoming phases of nursing evolution, we 
shall give some detail to the events which led up to 
it, and to its fortunes. 



36 A History of Nursing 

First in 1874 had the need for legal status for 
the nurse been publicly mentioned by the late Sir 
Henry (then Dr.) Acland in his preface to Miss 
Florence Lees' (Mrs. Dacre Craven) Handbook for 
Hospital Sisters. He there said : 

The Medical Act of 1858 allows women to be regis- 
tered as medical practitioners. It makes no provision 
for the registration of trained nurses, however complete 
their education, and however great their skill, whether 
as midwives or nurses. Many accomplished women 
might reasonably desire the name as well as the function 
of Superintendents of Hospitals or of Ward Sisters or of 
Nurses. At present they can have no such legal recog- 
nition of their qualifications in either department, as 
is obtained by Sisters who become school-mistresses 
or who are students and teachers of Art. That this ought 
to be remedied can hardly admit of doubt; but it rests 
with the women of England to decide whether what is 
here advocated has their support as well as their approval. 

In 1885, Surgeon- General (then Surgeon-Major) 
Evatt sent in to the War Office a memorandum con- 
taining a proposal to form a corps of 'Volunteer 
Female Nurses for Service in the Army Hospitals in 
the Field," with suggestions as to the incorporation 
of the nursing profession which can be regarded only 
as an inspiration of genius. In this he stated : 

It seems at first sight that the frmation of such a 
corps as I propose above, is purely for a Military Reserve 
for War; in point of fact it is for more than this. It is, 
I think, the first definite attempt to Incorporate the 
Nursing Profession. That profession is clearly evoluting 
itself out of the old disorder and chaos of untrained at- 



Great Britain and Ireland 37 

tendance on the sick. But up to the present date the 
Nursing Profession has never been taught to incorporate 
itself, to undertake its own self-government, to endeavour 
to work out its own future, to expel unworthy members 
from its ranks, to define its curriculum of training, to 
found a Diploma or Certificate of Efficiency, or to form 
a Pension Fund. But all these steps follow logically 
from the lines I have laid down. 

Suffice it to say that this remarkable document was 
pigeonholed by the War Office and no more was 
heard of it, and when trained nurses began to organise 
their profession two years later they were quite 
ignorant of its existence. 

In 1886, the question of registration of nurses was 
discussed by the Nursing and Domestic Management 
Committee of the Hospitals' Association of which Mr. 
Henry C. Burdett was the founder. But so little did 
Mr. Burdett then understand the professional aspect 
of registration that he wrote that in his opinion the 
Sectional Committee [on which were Matrons of 
hospitals] would do well to "confine their consider- 
ation of Registration to considering how far it is 
desirable or possible to establish a Register for 
Trained Nurses in connection with the Hospitals' 
Association, so that the Lady Superintendents and 
medical men may write from the country to the 
Association, and have a reasonable assurance that 
they will thus be able to ascertain the character of a 
nurse with reasonable certainty, and so protect them- 
selves from risks to which they are at present ex- 
posed." The Matrons composing the Sectional 
Committee then expressed the opinion, in connection 
with this scheme, that no nurse should be placed on 



38 A History of Nursing 

the Hospitals' Association's Register who had not 
received three years' training, but this professional 
opinion was ignored by the council of the association, 
which put forward a plan for registering any nurse 
who furnished satisfactory proof that she had worked 
for at least a year on the staff of a hospital or infirm- 
ary, and that she had been trained in the duties of a 
nurse. Their recommendation as to the professional 
qualifications of the nurses to be enrolled thus ig- 
nored, the Sectional Committee resigned in a body, 
the danger of the control of professional women by un- 
professional persons having been forcibly brought 
home to and thoroughly appreciated by them. Fol- 
lowing on this alarm signal came Mrs. Fenwick's invi- 
tation to hospital Matrons in London to assemble at 
her house, and nine, in all, responded, among them be- 
ing Miss Isla Stewart, Miss Catherine J. Wood, and 
Miss M. Mollett. Mrs. Fen wick presided, and it was 
decided that a professional association of nurses 
should be formed and that the Matrons of the princi- 
pal hospitals in the kingdom should be called to a 
conference to discuss the question. The conference 
was held, and it was unanimously resolved that a 
British Nurses' Association should be formed, its 
objects being also agreed upon. In January, 1888, 
the association was permanently organised and 
H.R.H. the Princess Christian accepted the Presi- 
dency. Instantly, The Hospital took up its policy of 
unremitting hostility. 

The association included medical men as members 
as well as nurses, and the nurse members had even 
generously elected medical men as honorary officers. 
[In England the term ''honorary" signifies an unpaid 



Great Britain and Ireland 39 

officer.] No doubt of the wisdom of this course 
occurred to the founders. They expected to meet 
honourable co-operation from all their members, and, 
at that early stage, it was sufficiently daring to or- 
ganise at all. It was the first time in modern history 
that nurses had asserted the right to associate to- 
gether for self-government, and to have ignored the 
medical profession would have seemed too revolu- 
tionary. On February 13, 1888, a public meeting was 
held at St. George's Hall. The chair was taken by 
Mr. (later Sir William) Savory, Senior Surgeon at 
St. Bartholomew's, and the objects of the association 
were explained to a crowded and enthusiastic audi- 
ence of medical men and nurses, after which members 
were enrolled. The first general meeting of members 
was held at the Middlesex on February 24th, its 
objects being defined as follows: 

( I ) To unite all qualified British nurses in member- 
ship of a recognised profession. (2) To provide for 
their registration on terms satisfactory to physicians 
and surgeons as evidence of their having received 
systematic training. (3) To associate them for 
their mutual help and protection and for the advance- 
ment in every way of their professional work. Lastly 
it was declared to be the immediate object of the as- 
sociation to obtain a Royal Charter of Incorporation. 

The Hospital having strongly advocated a sys- 
tem of registration for nurses when controlled by 
a lay body, now denounced the union of nurses for 
professional purposes, and advised managers of 
hospitals and nursing institutions throughout the 
country to "enact that no member of their staff 
should become a member of the new association." 



40 A History of Nursing 

As The Hospital was the organ of the " Hospitals' 
Association" it is probable that it voiced the senti- 
ments of many Governors. Some of the most power- 
ful of these authorities came out individually against 
the nurses' movement, notably those of St. Thomas's 
and of the London. In 1888, Mr. Henry Bonham- 
Carter, Secretary of the Nightingale Fund, published 
a pamphlet against the registration of nurses, and in 
the following year Miss Liickes, Matron of the Lon- 
don, widely circulated one against the British Nurses' 
Association. The Hospital published an anony- 
mous letter, suggesting that the association would 
include the "scum of the nursing profession'' and 
that nurses would join it "to obtain pseudo-respect- 
ability," which they could not get elsewhere. Mr. 
Burdett replied to protestations against these charges 
that they seemed "only a fair criticism." In 1889, 
a memorial was issued, signed by the representatives 
of ten London training schools, who 'noted with 
surprise the statement that the main object of the 
British Nurses' Association is in conformity with a 
great public want and a widespread professional 
demand." The point of view of these hospital 
authorities was that of many men to-day, who de- 
clare that 'women have everything they want." 
The memorial argues that enrolment in a common 
[State] register would lower the position of the best 
trained nurses, be detrimental to the advancement 
of the teaching of nursing, disadvantageous to the 
public, and injurious to the medical practitioner. 
These arguments rested on the contention that nurses 
should obtain references from their training schools 
throughout their entire career. The school authori- 



Great Britain and Ireland 41 

ties undertook neither to employ all their former 
pupils nor to be responsible for finding them employ- 
ment, yet claimed the power of making or marring 
their careers throughout the whole of their profes- 
sional life, a suggested domination which, we believe, 
has not been claimed over former students by any 
other schools, either professional or industrial. This 
memorial was signed, possibly under pressure, by 
the Matrons of seven of the ten hospitals. 

In 1899, tne British Nurses' Association invited 
the advice and assistance of the General Medical 
Council and the co-operation of the training schools 
for nurses throughout the kingdom, in establishing 
a system of registration of nurses, and in forming a 
council in connection with the association to carry 
it out. The General Medical Council replied in a 
resolution upholding the desirability of registration 
of nurses, but held that it should be carried out under 
a separate Act. Training school committees also 
generally refused assistance, on the ground that they 
existed for other purposes. In January, 1890, the 
first voluntary Registration Board was appointed 
by the British Nurses' Association and registration 
opened in February of that year. The Hospital 
now maligned the personal character of enrolled 
members, warning the public against a certain nurse 
whose name was mentioned, and refusing retraction 
when its statements were proved to be erroneous. 
Unfortunately, through dislike of publicity this 
nurse took no legal steps. Had she done so, others 
might have been saved from similar persecution. 

In 1891, the British Nurses' Association was 
granted by Queen Victoria the right to use the prefix 



42 A History of Nursing 

"Royal," and in 1892 it presented its formal Petition 
to Her Majesty the Queen in Council for the grant of 
a Royal Charter of Incorporation. The application 
aroused the utmost activity in the opposition ranks. 
The method of incorporation by Royal Charter is the 
most ancient and honourable by which this privilege 
can be obtained. The procedure is elaborate, and at 
one stage written reasons for and against are called 
for by public advertisements. Petitions against 
the charter were presented by the Council of the 
Nightingale Fund, the Committee of the Westminster 
Training School, and various executive officers, medi- 
cal men, and representatives of training schools and 
nursing institutions. 

On the other hand, lively interest was evoked, for, 
if granted, it would be the first time that a Royal 
Charter had been gained by an association of pro- 
fessional women. After royal and eminent medical 
signatures came the names of the Matrons, many of 
whom are still leading the campaign for progress and 
freedom. I 

In all, there were, supporting the petition, 1250 
medical men, 3700 nurses, and 4300 of the public. 

1 Mrs. Bedford Fenwick, Miss Isla Stewart (St. Bartholomew's), 
Miss G. M. Thorold (Middlesex), Miss C. S. Wood (Hospital for 
Sick Children, Great Ormond Street), Miss M. Breay (Metropoli- 
tan), Miss Beachcroft (Lincoln County), Miss M. N. Cureton 
(Addenbrooke's, Cambridge), Miss C. Forrest (York County), 
Miss L. Hogg (Head Sister, Royal Naval, Haslar), Miss Rogers 
(Leicester Infirmary), Miss G. Scott (Sussex County, Brighton), 
Miss M. G. Smith, (Royal Infirmary, Bristol), Miss R. F. Lumsden 
(Royal Infirmary, Aberdeen), Miss H. C. Poole (Adelaide, Dublin). 

In addition, the petition was signed by a large number of medical 
practitioners, Matrons, nurse members of the association, and chair- 
men and members of hospital committees, etc. 



Great Britain and Ireland 43 

Against it there were 264 medical men, 518 nurses, 
and 140 members of the general public. 

An inquiry was then held by three lords on behalf 
of the Privy Council, and both sides were heard 
through their respective counsel, Sir Horace Davey 
speaking for the Royal British Nurses' Association. 
The arguments on both sides are to-day so familiar 
to all nurses that we shall omit them. Some at- 
tempt was made to conjure with Miss Nightin- 
gale's name, but it was pointed out that for twenty 
odd years she had taken no direct part in nursing. 
Though opposed to the idea of State registration, 
one thing she had said was this: " Twenty or 
thirty years hence, when so much progress has 
been made that our present time is looked back 
upon as the time of bad nursing, this registration 
might do." 

As a result of the hearings the Committee recom- 
mended Her Majesty in Council to grant the Royal 
Charter, and on June 6th this was done. Thus the 
nursing profession possessed the powers, had it been 
permitted to use them, to organise trained nursing in 
a most honourable manner, and had it not been for 
internecine treachery this great reform would have 
been gradually accomplished. In 1894, at the In- 
ternational Congress of Hygiene and Demography 
held at Buda-Pesth, a paper signed by H.R.H. 
Princess Christian, President of the Royal British 
Nurses' Association, was presented, containing the 
following statement: "It is the hope of the Corpora- 
tion that the time is not far distant when the State 
will see the importance of recognising a definite 
Diploma of Nursing, and of giving its official sanction 



44 A History of Nursing 

to the maintenance of the Register of Trained 
Nurses." 

The future now looked bright. The large-minded 
women who had thought to build to the honour and 
protection of the calling they dearly loved, that its 
good name might shine brightly, were lifted high in 
spirit with hope and faith, and at a dinner of rejoic- 
ing, toasts and cheers rewarded the intrepid leaders. 
But the forces hostile to women's progress, defeated in 
open contest, plotted to capture the new association 
by indirect means. Up to this time, while the associa- 
tion had had to meet bitter onslaught from without, 
there had been complete unanimity within the ranks, 
but presently a malign influence from outside became 
apparent within the association itself, the object 
being to crush the power of the Charter. Further, 
although medical men had supported the nurses' 
petition for the Charter, when it became a question of 
carrying out the powers it conferred medical opinion 
was not by any means unanimous that the nurses 
themselves should exercise those powers. The hard 
fighting in the registration campaign had never 
centred around the register, but around the control- 
ling power behind it. Similarly, a struggle now 
ensued as to whether the medical men inside the as- 
sociation should control it and its policy, or whether 
the nurses themselves should exercise powers of self- 
government. Co-operation between certain medical 
officers and others within the association, and the 
arch anti-registration protagonist soon loomed up as 
a serious menace. Never has there been a more de- 
termined attempt to subjugate a women's associa- 
tion, and the history of the struggle, if it has 



Great Britain and Ireland 45 

answered any purpose, has afforded to the nurses of 
the world a lesson which many of them have taken 
to heart. 

A series of events now occurred, each one marking 
an advance in wresting power from the nurses by 
means of parliamentary tricks and subtleties and 
concentrating it in the hands of a small ring of men. 
The Executive Committee had a number of ex-officio 
members, who were thereby entitled to seats on the 
General Council. Such members were: leading 
medical practitioners, Matrons of the most important 
hospitals, heads of Army, Navy, and Indian Army 
Nursing services, and Mrs. Bedford Fenwick, the 
founder of the association. So long as these women, 
and especially Mrs. Fenwick, with her lightning-like 
intuition, keen judgment, and passion for justice, 
were in executive office, to usurp power would be very 
difficult and ways must be found to get rid of them. 
In October, 1894, it was suggested by a medical 
officer that the wording of the Bye-Laws was ambigu- 
ous and by reason of this imperfection it was pre- 
sumed that the founders were not entitled to seats on 
the General Council. A number of members there- 
upon, as was their right, called for a special meeting 
for the purpose of making the provision clear and 
unquestionable. The officers never convened the 
special meeting, thus distinctly violating the mem- 
bers' rights. 

In the following June the tension became acute. 
A member of the association did not receive the vot- 
ing paper to which she was entitled. She called at 
the association office and was refused it. She wrote 
a perfectly temperate statement of this to The 



46 A History of Nursing 

Nursing Record, saying that she was anxious to 
replace the names of the ex-officio Matrons on the 
list, and fearing that other members might have a 
similar experience, suggested that any one not hav- 
ing received a voting list should ask for it at the office. 
Extraordinary as it may sound, this nurse received 
a threatening letter from the association's secretary, 
through a fighting legal firm, on the day her letter 
was published. This attack upon her was authorised 
by the Executive Committee, and Mrs. Fenwick, as 
the editor of The Nursing Record, received a similar 
letter from the same firm. 

The offending member was next proceeded against 
by the Executive Committee (who had power to 
direct the erasure of a nurse's name from the register, 
after hearings) in such a way that she was forced to 
secure a legal adviser and to seek an injunction 
against the officers of the Royal British Nurses' 
Association restraining them from removing her 
name. She was sustained in the High Courts, 
and the association was ordered to pay the costs. 
Thus bravely and successfully were the rights of 
free speech and a free press defended by a nurse 
who deserves the gratitude of all for her intre- 
pidity. As though to rebuke the courts, the royal 
president now called a special meeting to consider 
a resolution condemning the woman who had been 
exonerated in a court of justice; the resolution 
was offered by the President of the Royal Col- 
lege of Physicians, who was not a member of the 
association; after a stormy debate, the chairman de- 
clared the resolution passed, and, when challenged, 
would not permit the votes to be counted. 



Great Britain and Ireland 47 

In January, 1896, came the decisive act of undoing, 
the betrayal of the members of the association on 
the fundamental principle for which they had founded 
it, namely, the State Registration of Trained Nurses. 
The British Medical Association had, in the previous 
year, passed the following resolution, proposed by 
Dr. Bedford Fenwick: 

That in the opinion of this meeting it is expedient 
that an Act of Parliament should, as soon as possible, 
be passed providing for the registration of medical, sur- 
gical, and obstetric nurses, and the Council of this 
Association are, therefore, requested to consider the 
matter and to take such measures as may seem to them 
advisable to obtain such legislation. 

In accordance with the resolution, the Parlia- 
mentary Bills Committee of the British Medical 
Association invited representatives of pursing bodies 
to confer with it on the subject. It was not, 
however, realised that to represent the views of 
nurses the representatives must themselves be 
trained nurses. Our space does not permit a full 
resume of this historic meeting and its prelimi- 
naries. Suffice it to say that the representa- 
tives of nursing bodies present were Mrs. Bedford 
Fenwick (Registered Nurses, a co-operative society) , 
Miss Isla Stewart (Matrons' Council), Dr. Bed- 
ford Fenwick, Miss M. Breay (St. John's House), 
Miss Annesley Kenealy (a nurse), who voted in 
favour of State Registration. Against it were : Miss 
Wedgewood (Delegate R.B.N.A.), Mr. Fardon (Hon. 
Medical Secretary R.B.N.A.), Miss J. Wilson (Hon. 
Secretary Midwives' Institute, not a nurse), Mr. H. 



48 A History of Nursing 

C. Burdett (National Pension Fund for Nurses), Mr. 
Pritchard (Secretary, Plaistow House for Nurses), 
and the representative of the Glasgow Maternity, 
who voted for a resolution : ' That a legal system of 
Registration of Nurses is inexpedient in principle, 
injurious to the best interests of nurses, and of 
doubtful public benefit." 

The resolution was passed by a majority of one, i.e. 
the vote of the Hon. Medical Secretary of the Royal 
British Nurses' Association, since dead. When sub- 
sequently taxed with his action, he excused himself 
by saying that he was not representing the association 
but the Middlesex Hospital. The answer is obvious. 
As an officer of an association formed for the purpose 
of obtaining State Registration of Nurses, he should 
either have refused to represent the hospital, or, if 
he decided to do so, should first have resigned his 
position in the Royal British Nurses' Association. 
The delegate nurse might have saved the day, and 
for her weak action deserves no excuse. From that 
day, the line of demarcation was deep between those 
who stood for foundation principles and those who 
had tricked them. 

Members of the association were at first inclined 
to believe that some extraordinary mistake had been 
made, which the executive committee would put 
right, but events proved that they had no such 
intention. 

It would seem, looking back, that it would have 
been better for all registrationists to have left the 
R.B.N.A. at this point. But British tenacity does 
not easily yield a cherished cause, and the nurses fol- 
lowed Benjamin Franklin's advice: 'Never resign." 



Great Britain and Ireland 49 

The next tactics of the medical parliamentarians 
brought on another lawsuit. Miss Margaret Breay, 
one of the charter members, instituted legal proceed- 
ings against the chairman of the annual meeting in 
1896. In 1894, a number of Matrons had protested 
against the irregular conduct of business, the un- 
satisfactory financial management (the 'funds were 
wasted), and the way in which the nurse members 
were overridden or ignored. Their protest was 
brushed aside, and at the next general council meet- 
ing they declared their opposition to the management 
had '" subjected them to every indignity which pre- 
meditated insult could inspire." They intended 
bringing a similar protest in 1895, but to ward it off 
certain medical members of the executive committee 
called twelve Matrons into conference and gave their 
word of honour that grievances should be redressed. 
The Matrons then consented not to make their pro- 
test. But when the meeting was over, every promise 
was repudiated. The Matrons then determined to 
protest at the annual meeting in 1896, and prepared 
a statement with resolution and motion which Miss 
Breay was to present. This was sent to the secretary 
as prescribed by the bye-laws on a certain early date, 
by registered post, for insertion in the agenda (order 
of business). The officers made some objections to 
the draft of the motion, and Miss Breay redrafted 
and returned it in an express registered letter. The 
letter was acknowledged, and Miss Breay's notice 
of motion appeared in the advertised order of business 
running as follows : 

That this meeting of the Corporation expresses its 
strong disapproval of the methods of management 

VOL. Ill 4 



50 A History of Nursing 

pursued by the present Executive Committee, especially 
concerning the manner in which the pledges given by the 
Association have been broken; in which the expenditure 
of the Association has been allowed so greatly to exceed 
its reliable income ; in which the provisions of the Charter 
and Bye-Laws have been violated; and in which a mem- 
ber of the Association has been compelled to appeal to 
the Court of Chancery for protection against the Execu- 
tive Committee. 

When the resolution was reached at the meeting, 
the honorary medical secretary rose to a point of 
order. The motion, he declared, had not been sent 
by registered post but merely in an express packet. 
He left it with the chairman to decide, etc. The 
chair instantly ruled that the resolution was out of 
order and on this frivolous technicality refused to 
allow it to be discussed. Miss Breay consequently 
resorted to the courts. In the City of London Court, 
before Mr. Commissioner Kerr and a jury, Mr. 
Scarlett appeared for the plaintiff (Miss Breay) and 
Mr. Muir Mackenzie for<the defendant, Sir James 
Crichton Browne, chairman of the meeting. The 
jury gave a verdict for Miss Breay, but as the case 
was held to be of public importance, the defendant 
was allowed to appeal and, in the Division Court of 
the Queen's Bench before Justices Wills and Wright, 
gained a technical point, it being held that Miss 
Breay should not have acted as an individual but 
together with others of the association. As the jury 
had rendered a just verdict, the plaintiff felt satisfied. 

The next step taken by the medical officers was 
toward admitting asylum attendants, who had 
worked for three years in asylums of over forty beds, 




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'Great Britain and Ireland 51 

to the register of trained nurses, but so emphatically 
was the objection voiced that this would be unfair 
to both, and so effective a public protest was made, 
that the proposal was dropped. 

In 1896-97, came the opportunity to rid themselves 
of the fearless and resolute woman whose presence 
on the executive committee vexed their spirits. Mrs. 
Fenwick was called to Greece as Superintendent of 
Nursing of the English contingent in the Greco - 
Turkish War (where she gave distinguished service, 
coming back with the Greek Red Cross), and during 
her absence the vice-chairman, hon. treasurer, hon. 
secretary, and certain members of the executive 
committee planned to secure the assent of the Lords 
of the Privy Council to an alteration in the bye- 
laws which reconstituted the executive committee 
without her name, and she was thus excluded from 
a voice in the society she had founded. The reversal 
of the policy of the Royal British Nurses' Association 
was now complete, and, on the resignation of the 
nurse secretary (a paid officer), the executive com- 
mittee selected the nominee of Sir Henry Burdett 
as her successor. Last of all, the addresses of nurse 
members were removed from the register, so that 
communication between them became impossible. 
In July, 1897, at the annual meeting, protests were 
made. Mrs. Fenwick, in a masterly address, reviewed 
the whole situation. Miss Clara Lee voiced the in- 
dignation of Irish nurses. A number of Matrons 
had appealed to public opinion through the press 
and then, there being nothing else to do, resigned. 
The Royal British Nurses' Association has never fully 
recovered from the disasters of that period, yet, in 



52 A History of Nursing 

1904, as we shall see later, it succeeded in throwing off 
its oligarchy sufficiently to declare once more the prin- 
ciple of registration for which it had originally stood. 

The lesson of these events was laid to heart by 
the nursing leaders, and they determined to make a 
fresh beginning, and to call into being organisations 
of nurses on other lines. Foremost among these 
was the Matrons' Council of Great Britain and 
Ireland, founded in May, 1894. Its founder and, 
until the time of her death, its president, was Miss 
Isla Stewart, whose great part in nursing progress 
we shall here imperfectly indicate. Miss Stewart 
was of an old Scotch family, and of a most genial, 
mellow personality. She was trained at St. Thomas's 
in 1879 and, while there, was reported to Miss Night- 
ingale as the most promising probationer of her 
class. She was Sister of a ward for four years, 
and then made a wider reputation by her man- 
agement of the Darenth Smallpox Camp with 
its thousand patients and large force of nurses. In 
1887, she was appointed Matron of St. Bartholo- 
mew's, succeeding Mrs. Fenwick, and died at her 
post of duty after twenty-four years of service, 
during which she stood forth as a strong tower in 
active furtherance of every progressive nursing move- 
ment. Mrs. Fen wick's unfailing friend and loyal 
ally, Miss Stewart carried on the training school with 
the broad, altruistic, cosmopolitan spirit which marks 
St. Bartholomew's nurses wherever they go. Force- 
ful and spirited, she never for a moment compromised 
on any question of policy, but boldly stood forth at 
every turn of the struggle as a champion of demo- 
cratic progress, yet so genial was she that even her 




Isla Stewart 

Late Matron, St. Bartholomew's Hospital 

'resident, Matrons' Council of Great Britain and Ireland; and Counci 

International Council of Nurses 




Great Britain and Ireland 53 

political enemies could not but be personal friends. 
While she lived, the nursing school of St. Bartholo- 
mew's stood for state registration, co-operation 
amongst nurses, professional emancipation, and the 
highest standards. The reactionaries waited for 
her death, and then brought about a reversal of her 
policy which must have been long planned, so sud- 
denly was it sprung. 

We lack space to speak of all that the Matrons' 
Council has done. Its wisdom in practical policies 
has been shown by the way in which it has placed 
itself on record, by resolutions, memorials, and re- 
quests, in every turn of public events. Its influence 
has been felt in every phase of nursing progress and 
it has unfailingly stood forth as the defender of the 
rights and opportunities of the great rank and file 
of nurses. Its aims have been high, its pronounce- 
ments sound, and it may long remain the most in- 
vigorating power in English nursing affairs. One 
of its seed-plantings we must record, for it is likely 
to flower in the near future: in 1903 the Matrons 
made to the authorities of Bedford College for Women 
the first proposal looking toward higher education 
for nurses on professional lines. Would that our 
pages were long enough to do justice to the many 
vigorous personalities of the Matrons' Council, who 
have shared in the upbuilding, labours, work and 
play of that splendid body! To Miss Margaret 
Breay, who was its honorary secretary during the 
twelve most strenuous years of its life, its fight- 
ing period, special honour is due. Her labours 
built up the Council. Its members are widely 
and well known. There is a model type of English 



54 A History of Nursing 

nurse who leads the world by the balance of her social 
charm, gifts of culture, and professional fibre, and she 
shows to the best advantage when holding position 
as Matron or Sister, in the cheery wards of the home- 
like English hospitals. 

When the International Council of Women met 
in London, in 1899, the Matrons' Council took an 
active part in securing the inclusion of nursing in 
the programme, 1 which gave the first opportunity 
for an international gathering of nurses, and it was at 
the annual conference of the Matrons' Council in 
that year that Mrs. Bedford Fen wick moved that 
; ' steps be taken to organise an International Council 
of Nurses." From her proposal grew the union, 
which in ten years' time embraced nurses of nearly 
as many countries. 2 In 1899, also, the English Ma- 
trons began the formation of training-school leagues 
(alumnse societies). The first was the League of 
St. Bartholomew's Hospital Certificated Nurses, 
founded by Miss Stewart. This was quickly fol- 
lowed by the League of St. John's House Nurses, the 
Royal South Hants Nurses' League, and others. 
Many of the leagues publish their own journals, 
maintaining them on a high plane of excellence. 

The vision of a national network of nurses' 
societies, centring in one national committee and 
affiliated with the International Council, had been 
clear in the minds of Mrs. Fenwick and her 
co-workers for some time. The international con- 

1 Reports, International Council of Women, 1899. Professional 
Section. 

2 See Reports, International Council of Nurses, Headquarters and 
Library, 431 Oxford Street, W. London. 



Great Britain and Ireland 55 

stitution had been so devised as to encourage 
national councils of self-governing nurses' societies, 
and in England Miss Stewart had held the hon- 
orary position which implied the international idea. 
This same year, 1899, saw the foundations laid, 
when, in October, at the Matrons' Council Mrs. 
Fenwick moved that the executive committee act 
as a provisional committee to consider the or- 
ganisation of a National Council of Nurses. This 
was done, and a draft constitution was presented 
the next year, when Mrs. Fenwick made a plea on the 
need of a strong society of nurses founded on the con- 
stitutional principle of representative government. 
In 1904, Miss Stewart, as honorary vice-president 
of the International Council of Nurses, convened a 
meeting of delegates of self-governing leagues and 
societies to discuss organisation and international 
affiliation, and a provisional committee was formed 
until the number of nurses represented should 
reach 3000. In 1908, the National Council of 
Nurses for Great Britain and Ireland was finally per- 
fected with fifteen affiliated societies, and the offi- 
cers elected were: Mrs. Bedford Fenwick, president; 
Miss Christina Forrest, honorary treasurer, and 
Miss Beatrice Cutler, honorary secretary. Thus 
the chain was made complete from the individual 
nurse to the international group. 

We return to the work for registration. Until 1902, 
the Matrons' Council had stood alone for this cause, 
and then, agreeing that the time for renewed effort 
was at hand, their sub-committee, on Mrs. Fenwick's 
motion, organised and launched the State Society for 
the Registration of Nurses, composed of individual 



56 A History of Nursing 

members, in May, 1902, with Miss Louisa Steven- 
son, LL.D. of Edinburgh, as president. In 1904, this 
society secured the introduction of a Nurses' Regis- 
tration Bill into the House of Commons by Dr. Far- 
quharson, M.P., and, at this point, the Royal British 
Nurses' Association regained control of its machinery 
and entered the field with another and similar bill. A 
period of high tension and activity now followed. 

Through the instrumentality of the State Society 
for Registration, a Select Committee of the House 
of Commons was appointed in 1904 'to consider 
the expediency of providing for the Registration of 
Nurses." After taking evidence during two years, 
this committee reported to Parliament as follows: 
' Your Committee are agreed that it is desirable that 
a Register of Nurses should be kept by a Central 
Body appointed by the State, and that while it is not 
desirable to prohibit unregistered persons from nurs- 
ing for gain, no person should be entitled to assume 
the designation of ' Registered Nurse ' whose name is 
not upon the Register." Thirty-three persons, in 
all, gave evidence, falling into the following lists: 

For Registration Matrons and nurses 1 1 

Medical men 9 

Lay persons 3 

Against Registration Matrons and nurses I 

Medical men 2 

Lay persons 4 

Neutral on Registration Medical men I 

Lay persons 2 

33 1 

1 Blue Book, "Report from the Select Committee on Registration 
of Nurses," 1904. House of Commons Papers. 



n 

n 




Louisa Stevenson, LL.D., Scotland 

First President, Society for State Registration of Train 




Great Britain and Ireland 57 

Thus, nursing opposition was reduced to one soli- 
tary figure, the Matron of the London Hospital, and, 
it must be remembered, had it been but one genera- 
tion earlier, hers would have been the prevailing 
point of view. 

Whilst the Select Committee were sitting, a new 
counter-attack was planned, which is known as ' ; The 
City Financiers' Scheme." Briefly, it was an attempt 
made by seven financiers of London to obtain from 
the Board of Trade a licence to form a society to be 
called "The Incorporated Society for Promoting the 
Higher Education of Nurses." No comment is neces- 
sary. Some of our old acquaintances were behind 
this, and only a gift of divination akin to "second 
sight' possessed by Mrs. Fen wick, and her prompt 
call to arms through the British Journal of Nursing 
saved British nurses from another defeat. 

After the Select Committee had reported, a depu- 
tation of nurses was received by the President of the 
Privy Council, the Earl of Crewe, who stated his 
opinion that the nurses' question was one of national 
importance; that nurses should have place on the 
central body set up under any Act, and that it 
could not be long before the subject occupied the 
serious attention of Parliament. In a second depu- 
tation of "antis," the representative of the Central 
Hospital Council for London offered as an alternative 
the publication of an Official Directory, showing 
simply what experience nurses had had. Further 
comment on this is also needless. But this project, 
really a negation of all previous '"anti" arguments, 
suddenly, in March, 1908, appeared as a bill before 
Parliament. No publicity whatever had been given 



58 A History of Nursing 

to it; nurses were absolutely unsuspicious of any 
attack from the rear. Two lines, only, in a daily 
paper, saying that a bill to provide for an official 
directory of nurses had been introduced into the 
House of Lords on the i8th of March by Lord Balfour 
of Burleigh, might well have escaped notice, but 
fortunately did not escape Mrs. Bedford Fenwick's 
vigilant eagle eye. Again an instantaneous alarm 
was sent forth for nurses to rally. But at that time 
they had no champion in the House of Lords. Mrs. 
Fen wick then appealed to Lord Amp thill, who, be- 
coming keenly convinced of the justice of their 
claims, consented to take up for them the weapons 
which he has loyally used in their defence from that 
time on. The facts and arguments were given him, 
and, supported by the Marquess of Lansdowne, he 
pressed the bill to defeat. So once more a small 
group of women, with no resource but brains and 
belief in the justice of their cause, no motive but a 
sense of duty to their profession, defended themselves 
against a powerful group of men both in and out of 
Parliament, and a measure intended for the subju- 
gation of nurses and the injury of State registration 
was the occasion for one of their greatest victories. 
Pressing home his advantage, Lord Ampthill suc- 
ceeded, in the session of 1908, in passing the Nurses' 
Registration Act successfully through the House of 
Lords, but it failed to get time for consideration in 
the House of Commons. 

The year 1909 was a notable one, as it saw the con- 
solidation of the State registration movement. The 
Royal British Nurses' Association, as we have seen, 
had again declared itself ; a bill to provide for regis- 



Great Britain and Ireland 59 

tration in Scotland had been introduced in 1909; 
the Irish and Scotch nurses' associations were firm 
supporters of registration ; the Fever Nurses' Associ- 
ation supported it, and the British Medical Associa- 
tion had three times passed affirmative resolutions. 
Mrs. Fen wick suggested that if all the motive power 
of these different societies could be concentrated in 
support of one bill, real progress might be made. A 
conference was therefore called by a conjoint letter 
signed on behalf of the Society for State Registration 
by Lord Ampthill and the Right Hon. R. C. Munro 
Ferguson, M.P. ; by Mr. Findlay, M.P., for the Royal 
British Nurses, and by Lord Inverclyde and Mr. 
Cleland, M.P., for the Association for Promoting 
the Registration of Nurses in Scotland. The emi- 
nently satisfactory result of this conference was an 
agreement to draw up one bill which should have 
unanimous support. Mrs. Fenwick's motion "that 
the principle of forming a standing central committee 
for the State registration of nurses be endorsed, the 
committee to be formed of delegates of societies 
supporting the movement," was accepted and the 
committee was formed, uniting and harmonising all 
registration workers under the chairmanship of Lord 
Ampthill, with Dr. Goodall and Mrs. Fenwick as 
honorary secretaries. It is this representative and 
influential committee, and the important societies it 
represents, which are promoting the unified bill in 
charge of the Right Hon. R. C. Munro Ferguson, 
M . P. , and here we leave them to their fortunes. There 
are those who believe that no woman's bill will seem 
important to the House of Commons until women are 
fully enfranchised, but that day cannot be far off. 



6o A History of Nursing 

One fact stands out in strong relief throughout all 
the history of the organisation of nursing in England, 
namely, that the opposition is to any form of legal 
status for trained nurses founded on the principle of 
self-government, and not to registration per se. This 
is evident from the proposal of the Hospitals* As- 
sociation to found a register of trained nurses ; the 
scheme of city financiers to make and maintain a 
register of persons to whom certificates of proficiency, 
or of training and proficiency, had been granted by 
their lay society, and by the proposal of the Central 
Hospital Council for London to found an official di- 
rectory of nurses. In each of these cases the register 
would have been controlled by the nurses' employers, 
but employers have hotly opposed the establishment 
of any form of registration in connection with which 
provision was made for any degree of self-govern- 
ment by the nurses themselves. This was the root 
of the bitter opposition to the British Nurses' Associ- 
ation on its foundation, and is behind the opposi- 
tion of the Central Hospital Council for London 
to the nurses' registration bill in Parliament. It 
is the determination of the employer to prevent co- 
operation amongst the employed. It says much for 
the courage, determination, and pluck of the women 
who are in the van of this fight and who have held 
a watching brief for the profession for all these years, 
that they have persistently and successfully fought 
all proposals for the government of the nursing pro- 
fession which did not provide for the adequate 
representation of the nurses themselves or their 
governing body, and that, despite intimidation 
and insult, many of the pioneers of reform are 




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Great Britain and Ireland 61 

still to be found working steadfastly for the desired 
end. 

In no other country have trained nurses in their 
work for legal status had to contend for so many 
years with the misrepresentations and hostility of the 
non-professionally interested nursing press. If the 
story of the struggle for nursing organisation in 
the United Kingdom serves as a lesson to the nurses 
of other nations in showing them where their strength 
and weakness lie, the quarters from which opposition 
will inevitably arise, and the tenacity of purpose, 
courage, and self-sacrifice needed by those who take 
the work of women's organisation in hand, this 
chapter of nursing history will not have been written 
in vain. 

On the 1 3th of August, 1910, the long and wonder- 
ful life of Miss Nightingale came to an end. By her 
express wish she was buried in the little churchyard 
at East Wellow, Hampshire, with her parents, while 
a whole world paid her homage. 

Scotland. Unlike England, the hospitals in Scot- 
land cannot trace their origin back to monastic 
times. During the Middle Ages the convents, and 
those establishments connected with them, were 
occasionally employed for the dispensing of medi- 
cines and the reception of the sick, but at the time 
of the Reformation the religious houses were swept 
away, and it was some time before the modern 
hospitals and infirmaries took their place. The 
oldest of the great hospitals in Scotland is the 
Royal Infirmary of Edinburgh, which was only 
opened in 1729, though schools of medicine and 



62 A History of Nursing 

dispensaries for the sick poor flourished long before 
that date. We can trace the inception of the first 
Scottish hospital in an early history of the Edin- 
burgh Royal Infirmary, from which the following 
quotation is taken: 

The Royal College of Physicians had attended for 
many years at their turns twice a week at their Hall to 
give advice to the poor gratis, yet they have very often 
had the mortification to see their advice and medicines 
prove unsuccessful, by their patients not having due 
care taken of them, and by their want of proper diet 
and lodging. 

The interest of the public having been aroused 
and sufficient funds collected, a house near the college 
was taken and fitted up for an infirmary. "While 
this was being done, they agreed with a Gentlewoman 
to be Mistress or Housekeeper, and allowed her to 
hire a servant or nurse for the Patients, both (be- 
sides having reasonable wages) to be entertained in 
the Infirmary." The "reasonable wage' 1 ' we find to 
have been 4, increased to 5 for the next Matron. 
The name of the gentlewoman engaged has been 
handed down in the minutes as Mrs. Nesbitt; un- 
fortunately, her life as a Matron was a short one ; she 
was discovered to be guilty of ' ' great extravagancy ' 
and dismissed for "charging more than she gave the 
patients." 

It is interesting to note the inventory which the 
next Matron, Mrs. Waldie, took over from Mrs. Nes- 
bitt : ' The furniture was delivered to her conforme 
to Inventory, with 4^ Ibs. of small candles, I Ib. 
great candle, containing seven, about 2 carts of 



Great Britain and Ireland 63 

coals, 6 pecks of meal and 2 pecks in bread, 4^ of 
groats, a peck and a half of sowing seeds, and 24 
chappin 1 bottles full of ale." 

Details are given in the hospital minutes of a 
quarrel between Mrs. Wai die and the first Resident, 
Robert McKinley, which gave a good deal of trouble 
to the managers. Mrs. Waldie was accused by him 
of twenty distinct misdemeanours; for example: 
not making the pudding according to the managers' 
orders (the recipe for this pudding is minuted!), 
keeping out six eggs and a pint of milk and substi- 
tuting water; only giving two baps 2 to three patients, 
instead of one to each; constantly entertaining 
friends, and giving them tea; making the sack- 
whey into posset for her own use, and rough 
speaking to the patients. Both parties were ad- 
monished Mrs. Waldie for speaking harshly to a 
patient, one Maitland, and McKinley for interfer- 
ing in the housekeeping department, and encourag- 
ing complaints from servants and patients. Mrs. 
Waldie was completely exonerated from the charges 
of dishonesty, which were found to be "false and 
malicious." 

Mrs. Waldie's story can be pretty well traced 
from the infirmary minutes. She was recommended 
to the managers by Lady Bruce, and had probably 
been at one time in her service, for she was ac- 
customed to a dietary much above what a person of 
her station could afford (we learn she could not do 
without her morning and evening tea, at a time when 
tea was 10: a lb.). She was a widow, with at least 

1 Chappin or chopin, a Scotch measure^ nearly one quart. 

2 A Scotch name for a breakfast roll. 



64 A History of Nursing 

one child dependent on her, for soon after coming 
she brought her daughter into the house without 
permission ; and the greater part of her time she was 
in monetary difficulties, not being able to meet her 
own and her daughter's expenditure out of her small 
salary. The 5 sterling had been increased in her 
second year in office to 100 Scots, i.e., 8:6:8 (one 
wonders why in 1734 her salary should have been 
expressed in the Scotch currency, which went out of 
use in 1707) ; Mrs. Waldie remained at her post about 
twelve years, and resigned on account of the infirmi- 
ties of old age. In seeking a new Matron, the 
managers stipulated that she should be a person 
competent to keep accounts, and they also added to 
the infirmary regulations a rule to the effect that all 
employees should be free from the care of children 
or persons depending on them. 

The temporary hospital was replaced by the old 
Royal Infirmary in 1738. With true Scottish fore- 
sight, it was planned to accommodate 228 beds, 
though for many years the funds only allowed of forty 
being occupied. The building was a national work- 
funds were raised all over the country ; those who were 
unable to give money contributed in kind timber, 
stone, lime, etc., or gave their labour as stonemasons, 
carters, etc., for so many days. 

In the earliest rules, published in 1749, we find 
mention made of the nurses. There are rules for 
the u Matron or Governess," the "ordinary nurses' 1 
and the "'supernumerary nurses." The whole staff 
is quaintly named (l the family " in all the old records. 
The !< ordinary nurses" were evidently the ward 
nurses, one in each ward, and the supernumerary 



Great Britain and Ireland 65 

nurses were for those patients who required con- 
stant attention night as well as day and patients' 
friends were eligible to be thus employed, with the 
permission of the physicians. No mention is made 
of night nurses, and it is probable that the average 
patient was not supposed to require nursing during 
the night. 

The great principles which Miss Nightingale 
laid down as the groundwork of nursing many years 
later were not entirely unknown, for we find great 
stress is put on the necessity of fresh air and good 
ventilation. Frequent references to the nurses occur 
in the early reports, and they appear, on the whole, 
to have satisfied the standards of the day. In 1777 
the "cares of the Matron, the assiduity of the ordin- 
ary nurses, and the assistance of others when the 
urgency of the particular cases requires them, the 
attention to the admission of external air," are enum- 
erated among the circumstances "which conspire to 
produce the best results." 

A history of the hospital published at this date 
includes some very explicit and amusing instructions 
to young physicians, concluding with the following 
advice : 

There is still a circumstance which, however trivial it 
may appear to some, is not unworthy the attention of a 
hospital physician : that is, to learn the dispositions of 
the different nurses. While one, from a natural impa- 
tience, can hardly tolerate the caprice of patients, whose 
bodies as well as minds are debilitated by the force of 
disease; another, too sympathising, may be disposed to 
palliate faults of patients which ought to be reported to 
the physician or surgeon. The physician by attending 

VOL. III. 5 



66 A History of Nursing 

to these differences will judge better how to regulate his 
conduct. . 

As time passed, the need of stricter discipline in 
the household made itself felt, and from the early 
forties in the last century, the managers had con- 
stantly under consideration the improvement of the 
nursing department. They increased the wages (from 
an old history, we learn that, in 1832, day nurses 
received 17: and night nurses 15: per month) - 
and added to the comfort of the nurses (the con- 
tributors remarking on the increased consumption 
of groceries, especially of tea, are told it is due to 
this cause). Stricter discipline was exercised and 
the Matron was relieved of the duty of superintend- 
ing the nurses, a new official, "the Superintendent of 
Nurses," being introduced; this official was not, 
however, herself a nurse, neither does she appear to 
have been a person of education and refinement, and 
it is not surprising to find the managers soon again 
considering how to improve the nursing department, 
while the new official's name disappeared from the 
report. In 1871, the first medical superintendent, 
Surgeon-Major Charles H. Fasson, drew up for the 
managers a report on the whole nursing arrange- 
ments, and after much consultation with the 
Nightingale Fund Committee in London, Miss 
Barclay, the first trained Lady Superintendent of 
Nurses, was appointed and came with a party of 
nurses from St. Thomas's (still remembered as "the 
Nightingales") to remodel the nursing department 
on the most approved system. 

There was an awakening in most of the Scottish 
hospitals in the early seventies ; the Royal Infirmary, 



Great Britain and Ireland 67 

Glasgow, was some years later in adopting the new 
system, but the Western Infirmary, established in 
1874, started with a training school for nurses. In 
Dundee, acting on the advice of their medical super- 
intendent, Dr. Robert Sinclair, the managers decided 
in 1873 to introduce the ''training-school system." 
Dr. Sinclair had drawn up a very full report in which 
he classified the nursing systems into : ( i ) The Free 
Service System; (2) Nursing by Sisterhoods; (3) 
The Training Establishment System. He drew 
special attention to the bad system of night nursing 
then in vogue, i.e., permanent night nurses, who 
combined the work of scrubbers and watchers, and 
were selected not as being capable, but because they 
were willing to attempt an amount of arduous labour 
not expected of any other class of women at a similar 
rate of remuneration. 

The managers of the Dundee Infirmary advertised 
for a Matron, stipulating that "applicants must 
have had a regular nursing training, and be fully 
able to superintend and train nurses." On De- 
cember 31, 1873, Mrs. Rebecca Strong, who later 
became so well known as a leader in Glasgow training 
schools, was appointed. It should not be forgotten 
that the Dundee managers were able to start the 
training school through the benefaction of a lady, 
Miss Jessie Graham of Kincaldrum, who left a large 
sum, the "Miss Jessie Graham Nursing Fund/' for 
the purpose of improving the nursing arrangements 
of the infirmary. Mrs. Strong remained in Dundee 
until 1879, and during her tenure of office she re- 
formed the nursing department and introduced the 
modern system. 



68 A History of Nursing 

The only hospital in Scotland which was nursed 
by a religious body was the Perth Infirmary, where 
the nursing was undertaken by the Protestant Evan- 
gelical Deaconesses of the Tottenham Green Hospital. 
This body, founded by Dr. Michael Laseron, was 
modelled on the lines of Kaiser s wer th ; the Sisters, 
when trained, were sent to work in all parts of the 
country, but remained under the central authority. 
Nine Sisters were sent to Perth in 1872 on the ap- 
plication of Dr. Stirling, a leading physician in the 
town who took a deep interest in the hospital. Their 
work is said to have been excellent. They were all 
ladies and had had some training ; they did the nurs- 
ing themselves and did not train probationers. After 
a little, friction arose between the managers and Dr. 
Laseron, the former disapproving of an imperium 
in imperio, and in 1877 Dr. Laseron took the occasion 
of a demand being made for nurses to go out to the 
Russo-Turkish war to withdraw most of the Sisters ; 
the managers first advertised for probationers, 
but found the dual system did not work, and 
they then made fresh arrangements and appointed 
Miss Logan, trained at the Royal Infirmary, Edin- 
burgh, as Matron. She is generally supposed to 
have been taken as his model by the poet Henley 
for the " Staff Nurse, New Style/ in his hospital 
poems. 

Henley, who was himself a patient for many 
weeks in the old Royal Infirmary, Edinburgh, has 
left us a picture of Mrs. Janet Porter, a fine speci- 
men of the old school ; she was employed for forty- 
seven years at the infirmary, and died at her post 
in 1890. 








IH 

- 

H c 



E 



Great Britain and Ireland 69 

Staff Nurse, Old Style 

The greater masters of the commonplace, 

Rembrandt and good Sir Walter only these 

Could paint her all to you ; experienced ease 

And antique liveliness and ponderous grace ; 

The sweet old roses of her sunken face ; 

The depth and malice of her sly grey eyes; 

The broad Scots tongue, that flatters, scolds, defies ; 

The thick Scots wit that fells you like a mace ; 

These thirty years has she been nursing here, 

Some of them under Syme, her hero still. 

Much is she worth and even more is made of her 

Patients and students hold her very dear ; 

The doctors love her, tease her, use her skill; 

They say "The Chief" himself is half afraid of her. 

Before passing on to the modern training schools, a 
few words are due to the nurses of the old school as 
they existed prior to 1870. Much has been written 
against them; there is no doubt that the majority 
were drawn from a low stratum of society, and were 
women of no education and wanting in refinement, 
unable to find other employment, a pilfering, rough, 
drinking set, the less said of such the better; but 
it is only an act of justice to state that among them 
were women of sterling character, whose records stand 
out the brighter for their dark setting. We have it 
on the testimony of those who knew the hospitals in 
early days that some of the nurses were skilful in their 
work, most faithful in the performance of their arduous 
duties, and earned the respect and gratitude which 
were their due. Dr. Sinclair, of Dundee, wrote : ' ' The 
day nurses are on the whole active and intelligent wo- 
men and are well informed concerning their duties." 



70 A History of Nursing 

We cannot gain a better idea of the work of the 
nurses of those days than by quoting from Dr. 
Sinclair's report: 

As a general rule, a large and small ward are allotted 
to a day and night nurse, who have charge of about thirty 
patients when their wards are full. The day nurses are 
on duty from 7 A.M., till 10 P.M. The night nurses from 
10 P.M., till nearly 3 P.M. the following day. Each is 
allowed four hours' leave of absence once a week, and 
time to attend morning and afternoon service every 
alternate Sunday. In the morning they sweep and dust 
their wards, ward furniture, sculleries, water-closets, 
and bathrooms; they clean such patients as are unable 
to do so themselves ; make the beds, clean utensils, change 
poultices, and the other dressings entrusted to them. In 
each division under the charge of a day and night nurse 
there are usually six fireplaces, which, when in operation, 
have to be cleaned by the night nurses. Each night 
nurse has to keep a flight of stairs clean, to wash poultice 
cloths, and, in the surgical wards, to wash bandages. 
In the midst of the morning work, the nurses and patients 
breakfast. The serving up and partaking of this meal, 
followed by the washing of dishes, occupies a considerable 
time. The day nurses are expected to be neatly dressed 
every morning before 10 o'clock, when the medical visit 
begins. . . . 

The Royal Infirmary, Glasgow, dates from the 
end of the i8th century. An early history of the 
infirmary by Dr. Moses Steven Buchanan published 
in 1832 is of great interest, and enters in detail into 
the management of the hospital and the conduct of 
the medical school. Mention is made of the Matron : 

I need not inform any of my readers that on no 



Great Britain and Ireland 71 

servant does the welfare of the establishment so much 
depend as on the Matron, and most fortunately it has 
happened that in no period of the history which I have 
investigated has there been a single fault laid to the 
charge of this department. On the contrary, I have seen 
everything to commend. . . . Little family differences 
there are occasionally, among so many young profes- 
sional clerks; and much good sense and forbearance, I 
doubt not, often required on the part of the Matron. 

The names of the Matrons from the opening are 
preserved. 

A very interesting relic exists in the form of a tomb- 
stone erected in the grounds to a former Matron, 
Mrs. Lyle. She married the secretary, a Mr. Robert 
Lamond, and died within two months (July, 1856). 
The inscription on the stone commences: 

To commemorate 
the virtues and services 
of a Matron of the Royal Infirmary. 
This stone has been erected with the permission of 
the Managers by one who loved her and mourns her death. 

and a long eulogy of Mrs. Lyle follows. Needless 
to say she was buried elsewhere. 

The Royal Infirmary did not adopt the training- 
school system of nursing very early. Mrs. Strong, 
who came from Dundee, was the first trained Matron 
and she was appointed in 1879. Lectures to the 
nurses were commenced in 1878 by Dr. J. W. Ander- 
son and Mr. W. G. Fleming, but no systematic 
training was attempted before Mrs. Strong's time. 

Miss Barclay, the first trained superintendent of 
nurses in Scotland, remained less than a year at the 



72 A History of Nursing 

Royal Infirmary, Edinburgh, and, retiring on account 
of her health, was succeeded by Miss A. L. Pringle. 
To Miss Pringle and her assistant and successor, Miss 
Spencer, are due the credit of making the Edinburgh 
school of nursing what it is to-day. These two 
ladies were, between them, for thirty-four years in 
charge of its fortunes. Miss Pringle at the time of 
her appointment was still under thirty years of age, 
but she had already distinguished herself by the 
qualities which earned her the name of 'the little 
general' in the accident ward of St. Thomas's 
Hospital (Old Surrey Gardens) , and she brought the 
enthusiasm of a reformer to her task. In 1887 she 
returned to St. Thomas's to succeed Mrs. Wardroper, 
and Miss F. E. Spencer followed her in Edinburgh. 
The three years' standard of training was adopted in 
the eighties, and it has recently been changed to four 
years. The present Royal Infirmary was opened in 
1879, an d in 1892 the new Nurses' Home was added. 
This home was very much in advance of others of 
that period, and has served as a model to many 
hospitals. From the commencement, many medical 
men were warm friends of the new movement, and 
the name of Dr. Joseph Bell, the well-known surgeon, 
will always be associated with the early days of the 
school. He was the first lecturer to the nurses, and 
while on the staff he held a clinic for them in his 
wards every Sunday morning. He was interested 
in everything that affected the nurses and was a 
great help to the authorities in carrying out reforms. 
It may truly be said that the development of modern 
nursing in Edinburgh owes much to Dr. Bell. 
In 1912 the Royal Infirmary is a training school 



Great Britain and Ireland 73 

with a staff of 270 nurses and over 900 beds. There 
is a board of direction of the education and ex- 
amination of nurses, and instruction, by means 
of lectures and classes, is given in medical, surgi- 
cal and gynecological nursing, hygiene, anatomy 
and physiology, materia medica, pharmacy, ban- 
daging, instruments, and sickroom cookery, each 
course of lectures being followed by an examination. 
Candidates must pass an examination in anat- 
omy and physiology on entering, and a further pre- 
liminary examination on the expiration of the three 
trial months, and before signing their agreement. 

The Royal Infirmary, Glasgow, is the only Scottish 
hospital which has instituted a preliminary training 
school. Mrs. Strong stated in her paper for the 
Congress of Nurses held in Buffalo, 1901, that Profes- 
sor 1 Macewen of Glasgow University was the first 
to suggest to her the possibility of an organised uni- 
form method for the technical instruction of nurses 
before entering hospital, and she instituted the 
scheme in 1893. The class work is in connection 
with St. Mungo's College, Glasgow. The time of 
training occupies three months. The pupils provide 
board and lodging at their own expense, and they 
also pay class fees. The scheme excludes all class 
work during the three years of training. 2 Recently 
the training has been lengthened to four years, and 
a final examination instituted. 

The Western Infirmary, Glasgow, is a modern 
institution, and the training of nurses was kept in 
view from the beginning of the infirmary in 1874; 

1 Now Sir William. 

2 See Transactions, Int. Congress of Nurses, Buffalo, 1901. 



74 A History of Nursing 

in the following year the regular course of training 
was started. The managers, together with the 
members of the medical and surgical staff, unani- 
mously agreed that nothing less than a period of 
three years could be entertained as adequate. 
Lectures and demonstrations were given and cases 
apportioned to be reported by the nurses, and at the 
end of the three years, an examination was held. 
Miss Clyde was then Matron. Dr. Mackintosh, 
the well-known hospital expert, became medical 
superintendent in 1892. Since then the training 
school has made rapid progress, and, in. 1898, the 
period of training was extended to four years. At 
present the courses of lectures on medical and sur- 
gical nursing are given by members of the medical 
and surgical staff, Matron and Assistant Matrons. 
One of the medical electricians lectures on X-ray 
and medical electricity, and cookery and massage 
are taught by trained, certificated teachers. A 
preliminary examination is given before the three 
months' term of probation expires, a junior exami- 
nation towards the end of the first year, and a final 
examination on the completion of three years' service. 
Examinations are divided into written, oral, and 
practical; marks are given for ward work, general 
conduct, etc., and nurses must gain an average of at 
least sixty-five per cent, of the total number of marks 
in each department before obtaining a pass-certifi- 
cate. The certificate is granted on the completion 
of four years' service. 

Until the year 1877 there was no "trained nursing " 
in the modern sense of the word in the North of 
Scotland. In Aberdeen, the old Royal Infirmary was 



Great Britain and Ireland 75 

in internal structure, management, and nursing in a 
thoroughly unsatisfactory state. The pioneer of 
modern nursing in the North was Miss Rachel 
Frances Lumsden, an Aberdeen lady, who had 
trained in various hospitals in London and worked 
under the Sisters of St. John. In 1 877 she was largely 
instrumental in founding the Royal Aberdeen 
Hospital for Sick Children, and for some years after 
its establishment she acted as honorary superintend- 
ent. In 1885 the state of the Royal Infirmary ur- 
gently demanded reformation, and the directors, 
recognising the value of Miss Lumsden's work, re- 
quested her to undertake this difficult task. In 
accepting as honorary superintendent she made 
it a sine qua non that she should have undivided 
authority, no medical superintendent being ap- 
pointed (as is usual in the larger Scottish hospitals), 
and she filled the post of both superintendent and 
superintendent of nurses for twelve years. During 
this period the three years' training for nurses was 
established, and the infirmary became a training 
school of recognised excellence. Miss Lumsden 
resigned in 1897. A large ward in one of the new 
pavilions, named for her, testifies to the value 
placed upon her work by the directors. She was 
one of the leading members in Scotland of the 
Royal British Nurses' Association. In 1891 she was 
appointed by the late Queen Victoria a member of 
the Council of the Scottish Board of the Queen 
Victoria Jubilee Institute of Nurses, and it was 
mainly due to her endeavours and those of her sister 
that district nursing was introduced into Aberdeen 
and the surrounding country. Her sister, Miss 



76 A History of Nursing 

Katharine Lumsden, succeeded her as honorary 
superintendent at the Children's Hospital, where she 
gave her services for sixteen years. 

The "lady probationer' 1 was never a feature of 
Scottish hospital life, and the schools are genuinely 
democratic, candidates, provided they are well 
educated and have natural refinement, being accepted 
from all ranks and classes of society, and nurses are 
salaried from the commencement of training. None 
of the hospitals has private nursing institutions 
attached. The hospitals are essentially training 
schools, and, when qualified, the pupil goes out to 
make her own way. There are many co-operations 
of nurses in the country, and one or two institutions 
still survive which were established in early days to 
train and send out private nurses. 

Nursing under the Local Government Board 
Trained sick nursing was introduced into the Scottish 
poorhouses about 1885, and the Local Government 
Board (Scotland) have kept a register of Poor Law 
nurses since that date. At present, in some of the 
hospitals fully-trained nurses alone are employed, 
while, in others, training schools for nurses are estab- 
lished. In 1907, the board instituted a scheme for the 
examination and certification of trained sick nurses, 
which has tended to raise the standard and improve 
the training in the poorhouse hospitals. In Glasgow, 
a trained nurse from one of the general infirmaries 
was first appointed to take charge of the hospital in 
Parliamentary Road in 1891, and she was granted a 
staff of eight trained nurses; by the year 1903, the 
staff of nurses and probationers had risen to between 
fifty and sixty. The training of probationers in that 



Great Britain and Ireland 77 

institution commenced in 1892. Lectures were 
given by the medical staff for several months in the 
year, and the period of training was for two years. 
In 1894, the Parochial Board of Glasgow City 
Parish agreed, at the request of the nurses them- 
selves, that the period of training should be ex- 
tended to three years, and a certificate bearing the 
name of the hospital w r as granted on the completion 
of training. 

There are now several large poorhouse hospitals 
under the Glasgow Parochial Board and all have 
training schools attached, where an excellent training 
is given. Since May, 1907, all qualifying examina- 
tions are conducted by the Local Government Board, 
under their scheme. A candidate must pass a pre- 
liminary examination in general education, unless 
she holds the leaving certificate from school. Lect- 
ures are given by the medical staff and the Matron 

i for seven months each year, and embrace the usual 
subjects, plus midwifery. The full course of training 
is three years. At the end of two years, a nurse who 

i has passed in two subjects in the Local Government 
Board examination, and has been satisfactory in 

i her work, is entered as a trained nurse on the roll of 
the board; but she cannot receive the special certifi- 
cate until after passing her examination in the four 
subjects and completing three years' training. Out- 
side Glasgow, a few only of the poorhouse hospitals 
attempt to train probationers ; the others including 
those in Edinburgh employ only trained nurses, 
who must be qualified for the L. G. B. roll. 

The erection of separate hospitals for fever patients 
is of recent date in Scotland, Formerly all fever 



78 A History of Nursing 

cases were treated in the general infirmaries, with 
the exception of pauper cases, which were sent to the 
fever wards of the poorhouses. Glasgow was the 
first city where the Town Council undertook the duty 
of dealing with infectious diseases, and in the "six- 
ties* 1 a fever hospital was opened in Parliament- 
ary Road. Shortly after, the Belvidere estate was 
bought and a hospital of wooden pavilions erected, 
these being gradually replaced by the fine modern 
buildings constituting the present City of Glasgow 
Fever Hospital. In connection with fever nursing 
Mrs. Sinclair's name stands out prominently as the 
pioneer in Scotland in this branch of nursing. She 
was herself trained in Liverpool, and, after some ex- 
perience in charge of the fever wards at Barnhill 
poorhouse, she became Matron of Belvidere in 1875, 
and remained in office for thirty years. She found 
the conditions for nurses much the same as those 
in the general infirmaries a few years earlier, but 
the nurses were of an even lower class, for service 
in a fever hospital was regarded as a dangerous 
duty. 

Mrs. Sinclair had a very uphill task, all reforms 
cost money, and expenditure had to be kept as low 
as possible ; but she was unwearying, and after years 
of persistent application accomplished all she desired. 
She began by introducing probationers, and soon 
attracted a better class of women to train, who helped 
by their example to stamp out the old abuses. She 
next improved the conditions for the nurses, and by 
degrees got proper accommodation, and raised the 
general standard of living. She was greatly helped 
by the medical superintendent, Dr. Allan, who in- 



Great Britain and Ireland 79 

terested himself in the training of the nurses, lectured 
to them, and wrote a text book for them (Notes on 
Fever Nursing). 

Mrs. Sinclair modelled the nursing department on 
the lines of a general hospital ; she instituted a three 
years' course of training, and believed in training her 
own nurses and putting them in charge of wards 
when certificated. This has been copied in the 
majority of the Scottish fever hospitals. In most of 
them probationers are engaged for three years. 
Lectures and classes are held, and ward instruction 
given, and certificates granted on the completion of 
the engagement. In most cases now the Matron is 
a fully-trained nurse, and the ward Sisters must hold 
a certificate for general as well as fever work. Re- 
cently the Local Government Board decided to in- 
stitute regular examinations for fever nurses, and 
to grant certificates similar to those now given to 
nurses trained in Poor Law hospitals. The scheme 
is entirely voluntary; it has been started in the 
belief that it will be of material benefit to the 
local authorities and to nurses trained in fever 
hospitals. 

Sanatorium Nursing. Scotland has been a pioneer 
in the nursing of tuberculosis, and the Royal Victoria 
Hospital for Consumption, Edinburgh, was one of 
the earliest institutions for open-air treatment in the 
kingdom. From a very small beginning in 1894, 
it is now an excellent example of the most modern 
type, where nursing is carried out on strictly scientific 
principles, and it has served as a school for nurses 
from all parts. Nurses residing in the hospital have 
also the advantage of studying the tuberculosis dis- 



8o A History of Nursing 

pensary system and visiting the patients in their 
own houses. The 'Edinburgh system' of dis- 
pensary work has gained a European fame. Many 
foreigners visit the institution. 

Mental Nursing. Hospital trained nurses were 
first appointed as Matrons in asylums about the 
year 1894, when Miss Berwick was appointed to 
Murthly and Miss Irvine to the Dundee Royal 
Asylum ; both these ladies had previously held posts 
as Sisters in general hospitals. At the present date 
there is scarcely an asylum in Scotland in which the 
Matron is not a trained nurse. In most of the larger 
ones the Assistant Matrons (to the number of six 
or seven), as well as the nurses in charge of the 
male and female hospitals, have also received general 
training. Dr. Robertson, formerly medical super- 
intendent at Larbert and at present at the Royal 
Asylum, Edinburgh, has been one of the most active 
advocates of general- trained nurses in asylums, and 
for many years he has employed them in increasing 
numbers. Hospital-trained Sisters at the head of 
mental wards have proved a great benefit to nurses 
and patients alike, and better discipline and superior 
nursing have followed on reliable supervision. The 
status and training of the asylum attendants have 
improved of late years. They are encouraged to 
become well instructed and competent in their own 
branch of nursing, and the majority enter for the 
examination of the Medico-Psychological Associa- 
tion. Many later complete their training in general 
hospitals. 

Midwifery. There are several good centres for 
obstetrical training in Scotland. With the exception 



Great Britain and Ireland 81 

of Dundee, none of the voluntary hospitals has 
maternity wards attached, and nurses must take the 
course at special hospitals. The training is on the 
same lines as in England, and pupils are prepared for 
the examinations of the Central Midwives' Board, 
but as the Midwives' Act of 1902 does not apply to 
Scotland, they have to go to England for examina- 
tion. At the time the act was framed, medical men 
did not see the need for such a measure, and opposed 
it being extended to Scotland. Since then, medical 
opinion has changed, and it is probable that when 
the new act is framed, Scotland will be included. 

Nursing organisation is still in its infancy north of 
the Tweed. The Royal British Nurses' Association 
never received wide recognition in Scotland, and it is 
only since 1907 that the movement for state regis- 
tration of nurses has found anything like general 
support, though there is now a growing feeling in 
its favour, and two Scottish Associations are repre- 
sented on the Central Committee for the State Re- 
gistration of Nurses in London. The apathy in the 
past was probably due to there being few pressing 
grievances, and Scottish nurses were slow to recognise 
i the benefits of registration. The conditions of work 
I have been good, and the field not yet over-crowded, 
i nor exploited to any great extent by the untrained or 
partially-trained nurse. Nurses have been chiefly 
drawn from a few large hospitals of recognised ex- 
fcellence, and this together with the early and gen- 
eral acceptance of the three-years' standard has 
given them a good professional status. 

Since the beginning of the present century many 
developments have taken place. We see small local 

VOL. III. 6 



82 A History of Nursing 

hospitals multiplying in all directions, and the special 
hospitals increasing in importance, and, in order to 
improve their status and attract probationers, they 
offer training and grant certificates. The Local 
Government Board has instituted examinations and 
certificates for fever nurses ; the asylums are anxious 
to improve their standards, and they prepare their 
nurses for the examinations of the Medico-Psycho- 
logical Association. Each is striving after excellence 
in its own branch. But the result for the public is 
very confusing ; without any fixed standard, it is im- 
possible for them to appreciate the true value of the 
various trainings, and there is no authoritative de- 
finition of the term "trained nurse" to guide them- 
The need of a central controlling expert body is 
gradually making itself widely felt, and the principle 
of state registration is becoming generally accepted. 

Ireland. The tradition of Irish hospitals and nurs- 
ing extends far back, almost to prehistoric times. In 
the heroic cycle of Finn and his Fianna, we read of 
warriors covered with wounds and glory being carried 
back to the camp, where they were met by bands of 
women, trained to nurse the wounded; how these 
took charge of the wounded heroes, and how, after a 
time, by the skill of the physicians and the care of 
the women, who "built them for battle once more," 
they were restored to health and vigour. In the 
Brehon laws we find directions for the erection of hos- 
pitals: " A hospital was to be built by every camp- 
it was to be opened to the North, the South, the East 
and the West there was always to be a stream of 
running water flowing through the hospital." 



Great Britain and Ireland 83 

That Ireland early attained an advanced degree 
of culture is matter of common knowledge, and the 
part taken by Irish missionaries in civilising central 
European countries has already been mentioned in 
connection with early hospitals. 1 The foundation of 
the earliest hospitals, even in France, is in many 
cases attributed to Irish monks. 2 Nursing by re- 
ligious orders dates as far back as the end of the fifth 
century, when the famous St. Brigid and her nuns 
attended the sick. As time went on almost every 
convent and monastery had its hospital and infirm- 
arium. In the fourteenth and fifteenth centuries, 
we find many accounts of hospitals attached to con- 
vents and monasteries: the Knights Templar alone 
had eight, while each had their special rules regarding 
the nursing of the sick. In succeeding centuries, the 
history of the religious orders and of their work is 
difficult to trace ; this being at first due to their pre- 
carious existence in times of foreign invasion, and 
later to the prejudices and bigotry engendered by 
religious strife. 

As forerunners of modern municipal hospitals 
there were, in mediaeval times, the Hospital of St. 
Stephen, the Styne (i3th century), and Allen's 
(:6th century), which provided in some measure for 
the sick poor. The eighteenth century saw the 
foundation of many municipal hospitals. That in 
Jervis Street was founded in 1718 by six surgeons 
in a small house, and then moved to the present site. 
The Steevens's dates from 1721. It is one of the most 
interesting of Irish hospitals, with an old-time and 

1 A History of Nursing, Vol. I. 

A Catholic Dictionary, Art. Charity. 



84 A History of Nursing 

dignified, almost human, personality. The portrait 
of its foundress, old Madam Steevens, who lived in 
it during her lifetime, hangs upon the wall of the 
board room, adding to the atmosphere of distinction 
that pervades it. Mercer's was founded in 1734, 
occupying the site of the old St. Stephen, and the 
Rotunda and Sir Patrick Dun's followed later. 
While up-to-date wards, new operating rooms, and 
other modern requirements have been fitted on to 
those of the Dublin hospitals that were built a century 
ago, they retain to a great extent their original aspect 
of great solidity, beautiful, old-fashioned architect- 
ural features wrought with cunning craftsmanship, 
and a certain stateliness. The rich strong colours in 
which their immense corridors and wards, too, are 
painted Indian and Pompeian reds and deep warm 
blues and browns harmonising perfectly with the 
outer atmosphere give them a special character all 
their own. 

During the eighteenth and two thirds of the nine- 
teenth century, these and similar institutions were 
served by untrained attendants of the "Sairey 
Gamp" type. So we read in the annals of hospitals of 
stipulations made by the governors or doctors that all 
new attendants must in future be able to read and 
write; numerous complaints, too, of drunkenness and 
carelessness of the attendants, of their washing their 
clothes in the wards, of their refusal to wear w r ashing 
dresses, of night attendants sleeping at their posts- 
often in vacant beds in the wards, and so on. 

Early in the nineteenth century, the religious orders 
of Ireland resumed their hereditary work in nursing, 
and have carried it on with signal excellence and with 



Great Britain and Ireland 85 

continuous progress in method and scope. In 1829, 
the penal laws by which Roman Catholics were for- 
bidden to hold property, and by which they endured 
many other disabilities, were repealed. Six years 
later, Mary Aikenhead, foundress of the Irish Sisters 
of Charity, established St. Vincent's Hospital in 
Dublin, the urgent need of such an institution having 
been made plain to her in the course of her ministra- 
tions amongst the sick and poor of the city. A sum 
of money given to her by Sister M. O'Ferrall enabled 
her to buy one of the fine Georgian mansions in St. 
Stephen's Green, which had been the town residence 
of the Earl of Meath, and there open a ward for twelve 
women. Before the end of the year, two more wards 
were ready. Then followed one for men; in 1841 
and 1858, still others were opened, the adjoining 
mansion of the Earl of Westmeath having been 
acquired. After these came a laundry, mortuary 
chapel, pathological laboratory, better accommoda- 
tion for the medical and nursing staff, and in 1909 
a modern theatre, the beds then numbering more 
than one hundred and fifty. The hospital is a school 
of medicine and its pathological laboratory and 
children's ward were the first in the city. 

The nursing institute of the order dates as far back 
as the year 1833, when the far-seeing foundress sent 
four Sisters to the Hopital de la Pitie in Paris, where 
they underwent a course of instruction in the system 
of nursing then in force. On their return they de- 
voted themselves to nursing the sick in the wards and 
to instructing others in the practice of nursing. It 
may therefore be said that the Sisters of Charity 
were the pioneers in Ireland in the movement per- 



86 A History of Nursing 

fee ted by Miss Nightingale, who had herself learnt 
much from their order in Paris. This system con- 
tinued until 1892, when, owing to the increasing 
demand on the part of the poor for admission to the 
hospital, and the limited number of the Sisters en- 
gaged in nursing, they began the training-school 
work to which we shall presently return. 

The order of the Sisters of Mercy, founded in 
Dublin, in 1831, early attained brilliant prestige in 
nursing. Its foundress, Mother Catherine McAuley 
(born in 1787; died in 1841), was a beautiful, benign, 
and highly cultured woman of great gifts for leader- 
ship. From this order went, in all, sixteen nuns to 
the Crimean hospitals, one or two of whom outlived 
Miss Nightingale. The Sisters unite the contempla- 
tive and the active life, and, though they take per- 
petual vows, maintain a vivacious and unaffected 
intercourse with those of the laity to whom their 
work relates them. They must have had hospital 
training at an early date, for they had skilled nurses 
when the Crimean War broke out, and in that same 
year, 1854, we find them taking over the nursing in 
the Jervis Street Hospital, while in 1857 they assumed 
that in the Mercy, of Cork, under Mother Josephine 
Ward. It was housed in a substantial old mansion, 
once the mayor's residence. In the early years the 
Sisters lived in it, but later had a small house given 
them for their own use. 

In 1867, the Sisters of Charity again took up the 
thread of history, when four Sisters arrived in Cork 
to take charge of the North Infirmary. Here there 
was room for about sixty patients. The accommo- 
dation was very restricted and the necessary equip- 



Great Britain and Ireland 87 

ment for an institution of the kind was quite lacking. 
The Sisters were much troubled with the state of 
affairs, and made many efforts to prevail on the ad- 
ministration to improve matters; their attempts for 
a long time met with no result:- 'No funds'" and 
"After all it is good enough for the poor." This at- 
titude was far from satisfying the Sisters; indeed, 
it only increased their zeal and strengthened their 
determination to make a trial of other means. With- 
out disclosing their project, they contrived to inter- 
est the ladies who contributed clothes for the sick, 
and among them was collected a small sum of money 
with which the Sisters renovated and improved one 
of the wards. In 1893, a lady bequeathed a large 
legacy to the infirmary, in memory of her father, 
formerly one of the medical staff. This sum provided 
a new building. From 1867 to 1895, the nursing was 
performed entirely by the Sisters. 

The first impetus towards modern professional 
nursing seems to have come from the Institution for 
Training Nurses, founded about 1866 by the efforts 
of Archbishop Trench and his wife, once intimately 
associated with Dr. Todd, who had done so much 
to establish the connection between the nursing of 
King's College Hospital and the St. John's Sisters. 
An extract from an early prospectus of the institution 
gives its aims: 

It is well known that much difficulty is found in ob- 
taining nurses properly qualified to attend on patients 
in hospitals and in private families, especially those of 
the middle classes and of the poor. The only remedy 
for this evil seems to be to raise up a better class of nurses 
who will undertake their work with a sense of duty. It 



88 / A History of Nursing 

is therefore proposed to establish, on a very small scale, 
a training institution for nurses, similar to those which 
have been found so successful in London and elsewhere. 
It is intended to provide a house or lodging near the 
hospital, capable of accommodating the Lady Super- 
intendent and eight nurses. . . . 

The committee of the training institution had al- 
ready, at the instance of the late Professor Haughton, 
approached the governors of Sir Patrick Dun's Hos- 
pital with the request that the nursing in its wards 
be placed in charge of the institution. The governors 
refused the offer on the ground that there was at the 
time no room to place at the disposal of the lady 
superintendent. In February, 1866, the committee 
approached the governors of Madam Steevens's with 
a similar request. The application was referred by 
the governors to the medical officers for consideration 
and the following enlightened response was made : 

The medical officers would be glad of the adoption of 
any arrangement which would improve the present state 
of the nursing of the hospital, which is most defective 
and discreditable to the institution. They would ac- 
cordingly do everything in their power to promote the 
success of the proposed plan. 

The governors then granted permission to the com- 
mittee of the institution to send nurses to the male 
surgical ward. Hence the evolution of the trained 
nurse in Madam Steevens's dates from the year 1866, 
at which time the hospital had already been receiving 
patients for one hundred and thirty-three years. In 
the minutes during that time, one frequently meets 
with entries relating to the conduct of the nurses, 



Great Britain and Ireland 89 

such as that in June, 1788: "Ordered that Jane 
Smith, otherwise Brown, the nurse, be discharged 
for drunkenness and neglect of duty immediately." 
The nurses, too, seem to have been allowed to live in 
the hospital with their families, and this, on more than 
one occasion, led to difficulties in management. Some 
of these women appear, however, to have served well 
and faithfully, as for instance one Frances Kane, who 
in 1784 was put on the allowance of the house "after 
twenty -four years' faithful service as one of the 
nursekeepers." Efforts had been made by the gov- 
ernors at various times to reform some of the abuses 
connected with the nursing; thus, in 1842, stringent 
rules were drawn up for the regulation of the nurses, 
the first of which was "That all nurses shall be able 
to read and write." This previously had not been 
considered essential, and there are many receipts for 
wages which are signed simply by the nurses' "mark." 
Such were some of the conditions with which Miss 
Beatty, the first lady superintendent of the Training 
Institution had to contend, when in August, 1866, 
she began her duties in the male surgical ward in 
Steevens's Hospital. Miss Beatty (of whom little is 
known except that she was trained at Netley) had 
under her a head nurse (trained) and two probation- 
ers. With this modest staff she set to work and, to 
quote the Medical Press and Circular for August, 
1866: 

In a very short time a complete new face was put on 
matters. There are twenty-eight beds in the ward, and 
these are constantly filled with every variety of accident 
and surgical disease, so that the labour in such a ward 
is immense; before attending to their surgical wants, 



90 A History of Nursing 

cleanliness was to be considered, and here a good deal 
of prejudice had to be overcome; some actually rebelled 
against having their faces and hands washed; others 
insisted in refusing sheets, and lying in blankets; while a 
sturdy few objected to having their morning smoke in 
bed discontinued; the razor and the scissors were put 
into requisition, and before noon a complete metamor- 
phosis had taken place. It is refreshing to see the un- 
ostentatious quiet way in which everything was done; 
no hurry, as might have been expected from beginners ; 
any commands given by the surgeons were accurately and 
immediately attended to ; in fact, everything showed that 
the system was under judicious management. Although 
little more than a week has passed since its commence- 
ment, a visible and real change for the better has taken 
place; and it was at once apparent that the faults under 
the old regime were to be attributed rather to ignorance 
and want of direction than carelessness. 

Unfortunately, though perhaps naturally, there 
seems to have been considerable and increasing fric- 
tion between the old and new systems the result 
being that at the end of about six months the con- 
nection between Steevens's and the Nurses' Training 
Institute was terminated, and the nursing arrange- 
ments of the hospital appear to have returned very 
much to their former condition. But before con- 
tinuing to trace the fortunes of the Institute we 
will follow the course of events in Steevens's to 
which it had given direction. Though unable to 
retain its services, both governors and medical offi- 
cers grew more and more dissatisfied after seeing 
its example set, and many endeavours were made to 
introduce order and system, either by the appoint- 
ment of suitable matrons or the framing of rules. 



Great Britain and Ireland 91 

The medical staff seem to have had a clearer idea of 
what was wrong than the governors, for in 1878 
they submitted to the latter the following unusually 
sensible report: 

The defective state of the nursing arrangements in 
the hospital has for a considerable time attracted the 
serious attention of the medical staff and has often been 
discussed by them. Although the more serious defects 
have, from time to time, been remedied on application 
to the Matron, yet the same irregularities have so fre- 
quently recurred that the medical committee have, with 
the knowledge and concurrence of the Matron, considered 
it their duty to consider the whole question of the nursing 
arrangements and their relation to the other adminis- 
trative departments of the hospital. . . . The committee 
find that the nurses are really employed as such, and 
many of them are very efficient, and all of them appear 
well intentioned and willing to discharge their duties, but 
some of them seem unable to do all that should be done 
as nurses. The wardmaids are supposed to do double 
duty as assistant nurses and scrubbers, which the com- 
mittee considers a most undesirable arrangement. The 
duties of assistant nurse and scrubber are quite incon- 
sistent with one another and should be discharged by 
different classes of persons. 

Nearly a year later the governors appointed a 
trained nurse as lady superintendent of nurses, a 
post separate from that of Matron. The lady they 
selected was Miss Franks, a Nightingale nurse, who 
came direct from St. Thomas's. She was placed in 
charge of the old nurses or attendants of the hospital, 
and in 1880 was authorised to engage a trained nurse 
as assistant. During the three or more years that 



92 A History of Nursin 



cr 



she remained at the Steevens's, the training school 
that she developed, in conjunction with a ladies' 
committee, was the first in which Roman Catholic 
lay nurses were trained, taking precedence of those 
established by Lady O'Hagan in England or the 
Marchioness of Bute in Scotland for training lay pu- 
pils of the Catholic religion. But still the machinery 
did not run smoothly; the lady superintendent was 
changed several times, her relation to the Matron 
being one that is always unsatisfactory; or perhaps 
the governors did not care for the ladies' committee, 
for in 1890 a committee appointed to recommend a 
method of remodelling the nursing service reported 

that the time has come when the hospital should or- 
ganise a training system of its own, providing accom- 
modation on the premises for the probationers while 
training, and utilising them, when trained, both in the 
hospital and in private nursing outside. The period of 
training to be two years, one year as probationer and one 
year as assistant nurse; examinations to be passed each 
year in practical and theoretical work; a certificate or 
diploma as a qualified nurse to be granted on satisfac- 
torily passing the second examination. 

Three years later the nursing was still not satis- 
factory, being expensive and inefficient. The lady 
superintendent sent in her resignation, and Miss B. 
M. Kelly was elected to the post. Miss Kelly is a 
fascinating and capable woman of strong personality 
and great energy. Under her hand the school has 
attained an important place and prestige. Before 
taking it she had had the distinction of being chosen 
as the first secular Matron of a training school under 
religious Sisters. 



Great Britain and Ireland 93 

After the separation from Steevens's the com- 
mittee of the Training Institution again applied to 
the governors of Sir Patrick Dun's, and now their 
offer was accepted. This hospital had been opened 
in 1808, after a long legal dispute over Sir Patrick 
Dun's property, and has had a notable record in the 
treatment of typhus fever, over ten thousand such 
cases having been brought into its wards during the 
famine years of 1826, 1828, 1846, and 1849. The 
Bye-Laws, printed when the hospital was opened, 
contain the usual quaint instructions for the Matron 
and nurses with which we have become familiar, but 
it is worthy of note that they order windows to be 
freely opened and the air to be kept fresh in the 
wards, directions very unusual at the beginning 
of the last century. In 1867, surgical and midwifery 
wards were opened, and as it was in this year too 
that the nursing was entrusted to the Training In- 
stitution, it is an important one in the annals of the 
hospital. The connection thus begun continued 
until 1883, when the governors considered that it 
was time to train their own probationers. The year 
1884 saw the appointment of Miss Huxley as Matron 
and Lady Superintendent and under her manage- 
ment the nurses' training school took rank among 
the first in the country. 

Miss Margaret Huxley, niece of the famous Huxley 
and daughter of one of equal loftiness of character, is 
one of that remarkably able group of w r omen who 
gathered at St. Bartholomew's when Mrs. Fenwick 
was Matron there, and who after w r ards carried the 
standards of their profession high in the forefront of 
progress wherever they went. She came to Dublin 



94 A History of Nursing 

in 1883 as Matron of the National Eye and Ear In- 
firmary, and in 1884 accepted the call to Dun's, where 
she worked without intermission until 1902 in her 
own words : 

steady, plodding hard work, no heroics of any sort, merely 
constant hard work. Before my advent there had been 
a Miss Johnston and a Miss Turner, both of whom, in 
some measure, prepared the ground for me. In those 
nineteen years I had the honour of training many ex- 
cellent women, who afterwards worked in various parts 
of the world. My greatest reward has been their good 
work and their appreciation of my method of training 
them ... at most all that can be said is, I gave honest 
work and full measure. . . . 

On leaving training-school work, Miss Huxley de- 
voted herself to 'Elpis," a private hospital of the 
most peaceful and comforting excellence, with Mrs. 
Frances E. Manning, who had been trained at Dun's, 
as her co-worker. Her successor in the hospital, 
Miss Louisa V. Haughton, initiated the first pre- 
liminary training course in Dublin in 1905. It is 
six weeks long and has proved very satisfactory. 

Numerous other hospitals made place for the 
modern system and ideals in the late decades of the 
century. Two of the early Irish-born and Irish 
trained Matrons were sisters, Ellinor and Bessie 
Lyons, trained at the Meath Hospital, both of whom 
took Matrons' posts in 1884, Ellinor in her alma 
mater and Bessie in the National Children's in 
Dublin. In 1888, the Adelaide appointed a nursing 
committee to bring about reforms, and as a result 
of its activity a trained superintendent of nurses was 



Great Britain and Ireland 95 

installed. In 1888, too, the allied hospitals Rich- 
mond, Whitworth, and Hard wick set their house in 
order under the vigorous management of Miss Annie 
MacDonnell, who had been one of Miss Huxley's 
first pupils. Miss MacDonnell's career was long and 
honourable. She served with distinction for twenty- 
one years in her hospital post, leaving it temporarily 
for the superintendency of the Irish hospital in the 
South African War, where she was decorated with the 
Royal Red Cross. She has been one of the strong 
figures in upbuilding work at home, as her sister 
was in India. The training of those pioneers was 
excellent, of the kind that develops character, nor 
was the intellectual side lacking, for the most eminent 
of medical men poured out lavishly for them all the 
treasures of their knowledge. 

The Rotunda Lying-in, the most famous hospital 
perhaps of its kind, was founded in 1745, and until 
1878 had the old style of nursing, yet not the worst 
Gamp type, for most of the women, though often 
illiterate, were well-intentioned and many became 
careful and experienced nurses. To the tact and 
patience of Dr. Atthill, who was elected Master of 
the Rotunda in 1878, were due the initial reforms. 
In his book, Recollections of an Irish Doctor, may be 
found entertaining details of his reconstructive work. 
Finally, in 1891, a trained superintendent of nurses 
was appointed, Miss Sara Hampson, who had been 
one of the first group of Nightingale nurses trained 
at St. Thomas's. She was an extremely able w r oman, 
of wide general knowledge, to whom the reorgani- 
sation of the Rotunda on modern lines is due. She 
gradually introduced perfected methods, and as 



96 A History of Nursing 

vacancies occurred on the staff filled them with nurses 
having had general training in addition to midwifery. 

Dublin has two other lying-in hospitals, the 
Coombe, founded in 1826, and the National Mater- 
nity, dating from 1894. Both have midwifery 
training schools. 

It is impossible in a short account to trace the evo- 
lution of modern nursing in all the hospitals in Dublin. 
But others were not far behind those described in 
opening training institutions similar to the original 
ones so long associated with the name of Archbishop 
Trench. The Red Cross Sisters, founded in 1884, 
nursed in the wards of the Meath and the National 
Children's hospitals. In 1894, the governors of the 
former severed their connection with the Reel Cross 
Nursing Sisters, and their probationers now work 
one year in the National Children's and three in the 
General Hospital, Birmingham. Similarly the City 
of Dublin Nursing Institution formerly supplied the 
City of Dublin and Mercer's hospitals with nurses. 
The former did not train its own nurses until 1900, 
nor the latter until February, 1911. 

We return to take up more in detail the train- 
ing-school work of the Catholic orders. This ex- 
tension of the Sisters' labours forms a unique phase 
in their long history. It brings them into close and 
direct relation with the modern nursing movement 
and the scientific outlook of modern medicine, knits 
common interests between the convent Sister and the 
self-supporting nurse in the world, and brings har- 
mony, mutual interest, and regard where before 
there were wide separation and complete absence of 
acquaintanceship. Now, united by common labours, 




In St. Vincent's Hosgital 




Great Britain and Ireland 97 

the trained religious nursing Sister and her secular 
probationers and graduates travel together toward 
the same goal, each adding something to the other's 
ideal of a common profession. 

The pioneer training school for lay nurses under 
the auspices of Irish nuns was that opened by the 
Sisters of Mercy in 1891, in Jervis Street, Dublin. 
The foundress of the school was Sister Mary Scho- 
lastica, who for many years had been Mother Super- 
ior, and the nurse whom she appointed as the first to 
start training-school work in a nun's hospital was, 
as we have seen, Miss Kelly. Sister Mary Scholas- 
tica lived until 1908 to see the success of her work. 
In that year the hospital suffered a grievous double 
loss in her death and that of Mr. Charles Kennedy, 
whose long life had been devoted to its upbuilding. 

Next was the school of the Sisters of Charity, 
opened in 1892 in St. Vincent's, Dublin. Here the 
order has an extensive and beautiful establishment 
combined of old buildings and new, into which have 
been set several historic mansions whose architectural 
charms bring many artists to their doors. The 
contrast between these old palaces, with their gardens, 
and the new, immaculate operating theatres and 
laboratories is a quaint and unusual one. The 
Sisters themselves undergo training, and during this 
time they discard their woollen habits and wear linen 
dresses. The nursing staff of the hospital consists 
of Sisters of Charity, fully trained, who have attended 
the lectures and passed the examinations qualifying 
them to register, should the sought-for nurse regis- 
tration act become law; secular qualified jutrses 
for "staff" or "senior" work, who have completed 



VOL. ni. i , 





98 A History of Nursing 

a period of at least two years in the wards ; and pro- 
bationers. A trained Matron supervises the nurses 
by day and an assistant Matron by night. The 
training of probationers receives the strictest atten- 
tion. They serve for fixed periods under supervision 
in medical and surgical wards, as required by the 
programme for state examination, receive practical 
lessons in domestic science as applied in the care of 
the sick, and attend regular courses of lectures on 
anatomy, physiology, hygiene, medical and surgical 
nursing. Preliminary and final examinations must 
be satisfactorily passed before they receive the cer- 
tificate of the institute, the entire service lasting 
four years. 

In 1 906, a co-operative bureau was opened for those 
nurses who, having completed their full four years' 
course, desired to remain connected with the hospital, 
and the nurses have shown their appreciation of 
this advantage by joining the co-operative staff in 
large numbers. 

St. Vincent's carries on an active social service 
department in connection with its out-patient work. 

Training schools were also opened by the Sisters 
of Charity in 1892 in the Children's Hospital, Dublin, 
now in Temple Street, and in 1895 in the North 
Infirmary in Cork with Sister Angela as Matron. 
The former has had a stirring history of persevering 
growth since its foundation in 1872. First managed 
by private individuals as an infirmary, it was confided 
in 1876 to the Sisters, who received it in debt, with 
a leaking roof, and no beds wherein they could sleep. 
So low was the exchequer that one day the Mother 
Superior had only three bad half -pence in her purse. 




,0 

5 

r^ 
+j 

-H 

a 

6 

ffi 

w 



O 




Great Britain and Ireland 99 

But the doctors and patients had met the Sisters 
with such warm welcome that difficulties were 
laughed at. A new building with grounds was finally 
secured, but before it was ready the old house had 
to be vacated. 

The Sisters had to settle in the stables, leaving the un- 
disputed possession of the dwelling house to the work- 
men by day. But as the men retired in the evening, 
the Sisters established themselves in their places, and 
having barred the doors and windows with any furniture 
or planks about the place, went to bed. They lived in 
sawdust and confusion, dealt in generalities, and left the 
inner details of housekeeping to Providence. [Report 
for 1911]. 

A lady superintendent now directs the school, and 
each ward is in charge of a trained Sister of Charity, 
who takes part in all the work, including that of 
the operating theatre, and assists in the training of 
nurses. 

We followed the Sisters of Mercy to the Jervis 
Street Hospital in Dublin, and to the Mercy, in Cork. 
They have also developed training-school work in 
the Mater Misericordia3, Dublin, the Mater Infirm- 
orum, Belfast, and the South Charitable Infirmary, 
Cork. The Mercy Sisters have charge, too, of many 
county and union hospitals, such as Sligo and Castle- 
rea, but in these the nuns do not train nurses. In 
the Mercy, at Cork, trained and certificated Sisters, 
in whose professional preparation no omissions are 
to be found, perform all the nursing and theatre work, 
assisted by lay nurses, both working harmoniously 
together and animated by the common desire to 



ioo A History of Nursing 

build up and strengthen the institution. Sisters and 
nurses alike wear white uniforms at all operations, 
the Sisters assist at all, and offer ready and complete 
fulfilment of medical and surgical orders. Their 
work has been commented on as having been brought 
to the highest point of modern perfection. The 
hospital was recognised in 191 1 as a medical teaching 
centre by the Senate of the Dublin University, and 
also as a school for nurses according to the require- 
ments of the Local Government Board, but still 
more significant and interesting from the nursing 
point of view is it to know that efforts are being put 
forth to make this a central teaching institution where 
Sisters of various orders may come to obtain certifi- 
cates as trained nurses. A special part of the house 
is to be set apart for this central school, and "every 
effort made to supply a long-felt want by giving the 
members of religious bodies full facilities for instruc- 
tion in all the minutiae of scientific nursing." 1 

The Mater Misericordias, Dublin, opened for pa- 
tients by the Mercy Sisters in 1861, has grown from 
forty to three hundred and sixty beds ; and from the 
first six trained Sisters a large staff and a lay training 
school, opened in 1891, have developed. The Mater 
is a noble set of buildings in the classic style and is 
peculiarly dear to the hearts of Irishmen. It is said 
that the funds for building it were largely gathered 
as a memorial to Mary Mother Aloysius after the 
Crimean War, in recognition of her wonderful ser- 
vices there, and that she donated it immediately for 
a hospital. Mother Mary, who thus appears as the 
foundress of the Mater, lived to be one of the last of 

1 Report of Mercy Hospital, Cork, 1910. 



Great Britain and Ireland 101 

the band of sixteen. England only recognised her 
war nursing in 1897, when Queen Victoria summoned 
her to Windsor to be decorated, but she was then 
too aged to take the journey, so the Royal Red Cross 
was sent to her. She died in 1908 in her ninety- 
fifth year. 

The wards of the Mater were filled with smallpox 
cases in 1866 and again in 1872, when the disease was 
epidemic, and the Sisters, in whose hands its entire 
management lies, have had their full share of active 
service. In 1911, the hospital celebrated its Golden 
Jubilee with great popular tributes of affection. 

In the year 1883, the old Mater Infirmorum, in 
Belfast, was founded. Being conveniently situated 
beside St. Paul's Convent, it was given in charge of 
the Sisters of Mercy. In the hands of the Sisters, 
the financial department, a very important one 
in the management of the hospital, has been an un- 
interrupted success, and also the watchful and care- 
ful nursing the Sisters being now skilled experts in 
the art produced results equally gratifying. 

Before the hospital had been long open the demand 
for admission to its wards became so numerous that 
the Sisters were obliged to refuse many deserving 
cases. This state of things they deplored and made 
urgent appeals to have it remedied appeals not 
made in vain. In the year 1902, the new Mater In- 
firmorum was opened. It is designed on the pavilion 
system, and took as its model the Mater Miseri- 
cordiae of Dublin. Arrangements were made for the 
training of nurses on the most approved methods, and 
on the 1 7th of February, 1902, a new school was 
opened, known as St. Philomena's Training School 



102 A History of Nursing 

for Nurses. To organise it came a Nightingale nurse 
of unusual ability and talents, Miss Pringle, whom 
Miss Nightingale had once called " a regular general," 
and who had previously occupied the post of Matron 
in St. Thomas's and in the Edinburgh Infirmary. 
The new undertaking was an arduous one, and Miss 
Pringle gave five years to it. Miss May, an English- 
woman, succeeded her, and followed closely on her 
methods. In 1909, Miss Hannan, an Irish woman 
trained in St. Vincent's, Dublin, was appointed 
Matron. She is a very progressive woman, an ad- 
vocate of a three years' course of nursing in the 
wards and six months' fever training; a great tem- 
perance advocate, a believer in state registration, 
and she has succeeded in making the Mother Superior 
(who, like the Sisters, is a trained and certificated 
nurse) and nearly all her nurses state registrationists 
also. She looks forward hopefully to the day when 
a nurses' registration bill shall be passed for Great 
Britain and Ireland. 

One of the most important centres of nursing under 
the Mercy Sisters is the South Charitable Infirmary 
and County Hospital, Cork. The infirmary was 
established in 1773, an' 1 ' Miss Franklin was men- 
tioned as Matron in 1870. Some years later the City 
of Dublin Nursing Institute became responsible for 
the nursing, terminating its connection in 1891. A 
number of changes took place, in the midst of which 
Miss Franklin, who had been for forty years in the 
infirmary, died, while other Matrons came and 
went. Finally, the trustees decided to select one 
from a religious order, and Sister Mary Albeus 
Fogarty, of the Mercy order, St. Marie's of the Isle, 



Great Britain and Ireland 103 

was placed at the head of the nursing department, 
with several assistant Sisters. All of them held 
nursing certificates, and had as well the skill in house- 
hold arts in which the religious orders have always 
excelled. Sister M. Albeus and her staff brought 
much needed order and comfort into the place, where 
at first their own quarters were very restricted. 
Soon after taking charge, Sister M. Albeus sug- 
gested to the nursing committee an alteration of the 
bye-law r s, and was authorised to revise them as she 
found best. Her new scheme, on being presented, 
was unanimously adopted and is still in force. In 
it the position of the Matron as head of the nursing 
department was definitely recognised and her powers 
clearly defined. The nursing staff has increased 
steadily; in 1902 numbering thirty-six, eight years 
later fifty-two. The nurses are of all religious denom- 
inations. A high standard of education is demanded 
of probationers, and their training includes service 
in the North Fever Hospital and the House of Re- 
covery, where salaried members of the South Infirm- 
ary nursing staff direct the pupil nurses. Lectures 
are given by Sister M. Albeus and the members of 
the medical staff and house "nen. The Charge Sisters 
(head nurses) teach the practical work. The great- 
est friendliness exists between the religious Sisters 
and the nursing staff; there is perfect harmony 
amongst them, their one aim being the well-being 
of the institution and of the sick and suffering. The 
medical and surgical staff, appreciating the results 
of skilful management, are ready in acknowledg- 
ment of Sister M. Albeus 's great interest in all 
details relating to the patients' care, and her will- 



104 A History of Nursing 

ingness to assist the staff in all matters connected 
with the welfare of the hospital, while the nurses 
work excellently in an atmosphere of ready service. 

Among all her other responsibilities, Sister M. 
Albeus is an armed and loyal ally in the conflict with 
Parliament over the nurses' registration act. She 
is a member of the Matrons' Council of Great Britain 
and Ireland, one of the executive committee of the 
Irish Nurses' Association, and frequently lends her 
name and gives her time to committee work on edu- 
cational and professional matters. 

THE CITY OF DUBLIN NURSING INSTITUTION 

To understand the unique position which this In- 
stitution has occupied in the evolution of trained 
nursing in Ireland, since its foundation in 1884, one 
must recall the conditions under which Dublin 
hospitals then laboured, when the modern system 
of trained hospital nursing had barely come into 
existence. In those days, indeed, the most distin- 
guished members of the surgical staff might often have 
been seen assisting in the bedmaking of acute cases. 
Through the action of a group of gentlemen (Gover- 
nors of the City of Dublin Hospital or members of 
its medical staff, who, seeing the necessitous state of 
the nursing, subscribed 1000 as a foundation), the 
City of Dublin Nursing Institution was established, 
the subscribers forming the board of directors, with 
the late Right Hon. Gerald FitzGibbon, LL.D., Lord 
Justice of Appeal, as the chairman, and the late Sur- 
geon W. I. Wheeler, its first honorary secretary. The 
purpose of the Institution was, primarily, to aid the 



Great Britain and Ireland 105 

City of Dublin Hospital, and also to provide train- 
ing and en ployment for Irish nurses. From 1884 
until 1900 i supplied all the nursing required by the 
hospital and bore all the expenses of the salaries and 
support of the probationers, besides paying the hos- 
pital an additional sum for the training thus afforded. 

At first the nurses and probationers on duty were 
in charge of the hospital Matron, the late Miss Susan 
Beresford, a sympathetic and cultivated Irishwoman, 
under whose genial rule they were very happy, though 
the small number of nurses considered sufficient in 
the eighties obliged them to work very hard indeed, 
and with nmch less off-duty time than is, happily, 
customary it< these days. Later, as the staff of the 
Institution increased, it was found necessary to have 
its own Ma> on, and Miss FitzGerald, the elder 
daughter of th_ Right Reverend William FitzGerald, 
Lord Bishop of Killaloe, who had been trained at the 
City of Dublin, and subsequently at the London, 
returned to take up its management. 

In 1898, for the second time, the nursing in Mercer's 
Hospital was undertaken by the Institution the 
latter bearing all the expense of salaries, clothing, and 
voluntary replacement of nurses when ill or on leave, 
in addition to paying the hospital large fees for the 
training thus afforded. This arrangement continued 
until the spring of 1909, when it was first modified, 
and in February, 1911, terminated, and the nurses 
withdrawn, the hospital being then in a position to 
organise its own nursing staff. 

The annual reports show the wide sphere of work 
entered upon by this pioneer institution from the 
first and the aid it has afforded to many hospitals and 



io6 A History of Nursing 

infirmaries throughout Ireland, by send-'.ng a staff 
of nurses and probationers to organise the nursing 
arrangements in them when required. 

An extract is subjoined from the reports of the 
years 1890 and 1892 regarding the part taken by it 
in the establishment of the nursing of the sick poor 
in Dublin: 

The Council of the Queen Victoria's Jubilee Institute 
for Nurses last year invited the co-operation of the 
Institution in establishing a system of district nursing 
for the poor of Dublin in their own homes. The directors 
undertook to devote a considerable sum to this object, 
on the terms that the Institution should be recognised 
as a District Home for Queen's Nurses for the poor. 
Four trained nurses were assigned to this duty ; they have 
each received three months' training in ' maternity nurs- 
ing' and two of them have received, in addition, six 
months' 'district training' in London. They are now 
awaiting the arrival in Dublin of Miss Dunn, an Irish 
woman, to be lady superintendent of district nursing 
appointed by the council and the assignment of their 
district. 

The annual expense of maintaining a staff of four nurses, 
who will be devoted exclusively to the district nursing 
of the poor in their own homes, is estimated at 240, 
of which the Queen's Institute will contribute 100, 
the City of Dublin Nursing Institution defraying the 
balance out of its own funds. x 

The Council of the Queen Victoria's Jubilee Institute 
. . . has made an agreement with the Institution for 
training two Roman Catholic probationers throughout 
the year, who, when qualified, are to be employed as 

1 Report, April 30, 1890, p. 5. 



Great Britain and Ireland 107 

district nurses for the poor of Dublin. By preparing a 
succession o f qualified nurses for this duty, the Institution 
is enabled to aid in extending the benefits of Her 
Majesty's bounty throughout Ireland, and to qualify 
Irish-trained district nurses for employment. 1 

Early in 1(890 the Institution had the misfortune 
to lose, after a few days' illness, the able services of 
Miss FitzGerald, whose personal interest in the pro- 
gress of the staff in her charge is still a grateful 
memory to many of them. Upon her death, Mrs. 
Kildare Treacy was appointed by the directors in 
her stead. Mrs. Treacy, who presided over her 
"family" from that date until her death, was a true 
and loyal Irish woman, her county being "Gallant 
Tipperary"; she acknowledged, with pride, that she 
had received her training as a hospital nurse in Ire- 
land, and devoted her life, her wit, her humour, and 
her energy, to Irish nursing affairs. Having lost 
her parents and her husband early in life, she decided 
to be trained in hospital nursing, and having over- 
come the family opposition, inevitable in those days, 
entered the City of Dublin Nursing Institution as a 
probationer in 1887. Never was there a warmer 
enthusiasm for all nursing progress, nor a kinder 
heart than Mrs. Treacy's. Quite suddenly, in the 
winter of 1912, in the prime of her work and life, she 
was taken away by death. 

A notable event in the history of the Institution 
was the bestowal by Queen Victoria of the decoration 
of the Order of St. John of Jerusalem in England upon 
eleven of the nurses, for devoted and heroic services 

1 Report, i8g2, p. 4. 



io8 A History of Nursing 

in nursing the sick poor during an epidemic of typhus 
fever, which raged in an island off the wejst coast of 
Ireland in 1897. The passage to the island was one 
of considerable peril, and the conditions under which 
the people were nursed were improvised and or- 
ganised by the nurses with extreme diilficulty, but 
though almost all the population (all fisher folk, and 
very poor) of the island contracted the disease, only 
one death occurred, that of an already tuberculous 
patient. The enrolment of these the first nurses 
to be honoured by admission to the Order of St. 
John was testimony to their fidelity and self- 
sacrifice, of which the directors and staff are justly 
proud. A number of the staff offered th ^ir services to, 
and were accepted by, the Army Nursing Reserve 
Committee in London on the outbreak of the war in 
South Africa, where their nursing services to the sick 
and wounded were highly valued. 

The Institution is self-supporting. The earnings 
of the nurses are divided among them after the up- 
keep has been provided for, and there is also a pension 
fund from which grants are made. During the first 
twenty-seven years of the Institution's existence, 
about one thousand probationers passed through its 
halls into the world. 

District Nursing. Dublin has two district nursing 
centres, one Catholic and the other Protestant, both 
affiliated with the Queen Victoria Jubilee Institute. 
The Protestant Home, called St. Patrick's, was the 
first centre in Ireland, and was founded in 1875. 
Prior to this the Dublin Women's Work Association 
was reaching the Protestant poor of the city by 
means of Bible- women, mothers' meetings, and other 



rreat Britain and Ireland 109 

parochial activities. As this organisation extended, 
it was seen that an enormous benefit would be con- 
ferred upon the poor by providing them with trained 
nursing in their own homes, and a district nurse 
was engaged from London. So started the scheme of 
district nursing which now covers Ireland as a net- 
work in every direction. From the first the nursing 
work was carried out on strictly unsectarian lines. 
In the early days there were many obstacles to be 
overcome, same financial, and some due to opposi- 
tion from various sources. However, year by year 
the nurses made their way. Ten years after the 
home was started, a superintendent and three nurses 
had a yearly a /erage of about eleven thousand visits. 
In 1890, the staff of St. Patrick's Home was affiliated 
with the Jubilee Nurses, and it was recognised as a 
centre for training nurses for district work. Many 
districts in Ireland and elsewhere have been supplied 
from this home. 

St. Lawrence's, the second district nursing centre 
in Dublin, is the Catholic Home. It was opened in 
1890, the Archbishop of Dublin being patron. Its 
active usefulness is indicated by a recent report: 

The year which ended on October 31, 1910, was one 
of expansion and increase of work . . . The Home 
consists of the lady superintendent, a staff nurse, and a 
varying number of fully qualified hospital nurses, who 
receive here, in a six months' course, that special class of 
training required by those who devote themselves to 
nursing the sick poor in their own homes. Nineteen 
nurses were trained here during the past year for this 
special work, and, of these, fourteen have been already 
sent to different places throughout Ireland, including 



i io A History of Nursing 

eight new districts which are now served by Jubilee 
nurses. . . . During the year, 3614 cases have been 
attended . . . 1000 more than last year. . . . The great- 
est ambition of the committee is to be able to say, as 
each year comes round, that no applicant for a nurse, 
provided it comes within our rules, has had to be refused, 
and at the same time to be satisfied that each particular 
case is efficiently treated. 1 

The pioneer district-nursing journal, the Queen's 
Nurses' Magazine, owns Ireland as its birthplace. 
It was mothered, edited, and long financed by Lady 
Hermione Blackwood, who gave it distinct character 
by interpreting all current events, both social and 
political, which could affect nurses and their work, 
and united in its pages Irish legend and romance, 
district news, and intellectual taste. In 1910, the 
Queen's Institute adopted it as its official publication 
and became responsible for its business end. 2 Lady 
Hermione, who is herself a Queen's Nurse and active 
in Irish organisation affairs, comes naturally by her 
altruism and spirituality, for she is a daughter of 
the Lady Dufferin whose work in bringing medical 
and nursing relief to the women of India we shall 
try to tell in another chapter, and of the late Marquis 
of Dufferin and Ava, whose mother was the daughter 
of Sheridan. 

The Irish Nurses' Association. As the training of 
nurses became systematised and nursing acknow- 
ledged as an honourable profession or calling, the 
need of organisation became felt. The first idea that 

1 Report of 1909-1910. 

* It may be obtained at 58, Victoria St., London, S. W. 



iGreat Britain and Ireland in 



arose was to establish a common centre where nurses 
could meet for business purposes, or to discuss their 
professional affairs, and where they could have the 
opportunity of cultivating a spirit of comradeship. 
It was suggested that a nurses' club be formed and 
the suggestion was warmly received. In October, 
1900, a meeting was called, and an executive com- 
mittee formed, consisting of Miss Huxley, president, 
Miss Carson Rae, treasurer, Miss Hampson, secre- 
tary, and some six others. 

Mrs. Treacy, reminiscent on nursing affairs, gave 
the history of the inception of organisation: 

My memory takes me back to what I may be permitted 
to call the twilight of the dawn of trained nursing in 
Dublin. . . . The great training schools had been founded, 
but there was 110 effort at organisation or association 
for Matron or nurse outside the all-absorbing interests 
of their own hospitals and institutions, until about eight 
or ten years back. When her late Majesty, Queen 
Victoria, visited Ireland during the spring of 1900, it 
occurred to some of the Dublin Matrons that Irish nurses 
would wish to offer her an address of welcome; and es- 
pecially as it was remembered that, to the initiative of 
this great and good sovereign, the establishment of trained 
nursing for the sick poor was due. . . . With this idea 
we proceeded to communicate with the Matrons and 
nurses of Dublin, and throughout Ireland, a more difficult 
matter than at first sight appears, as by this time we had 
become a very numerous body (some thirty-five Matrons 
in Dublin alone) and we did not quite know where to 
find all of ourselves. However, we appointed a committee 
and met a few times in a waiting-room of one of the 
hospitals, kindly lent us for this purpose, and arranged 
the address and its presentation ; and here let me acknow- 



ii2 A History of Nursing 

ledge the generous and valuable help always given to 
any of our projects by the press of Ireland. 

It was quickly realised that the amount of association 
which we had had in this connection was so helpful and 
pleasant, that we decided to continue it, if possible: 
our committee was again summoned, a secretary ap- 
pointed, and a Nurses Club launched in a couple of 
rooms in a central position in Dublin, with Miss Huxley 
as our first president. 

From this simple beginning we have now the Irish 
Nurses' Association, with a wide membership, embracing 
the Irish Provinces, and forming a bond of union with 
the many countries in which our Irish nurses travel. 
The rooms of the association are a pleasant meeting- 
place, amply provided with professional a, id other litera- 
ture. Lectures are given by eminent members of the 
medical profession, and upon many other interesting 
subjects by friends of distinction in the world of art and 
philanthropy. 

Here also is a centre and an executive, through which 
the association has received help and counsel from 
eminent Irish members of Parliament, in bringing mat- 
ters of importance to nurses before the Local Govern- 
ment Board of Ireland, the Board of Trade in London 
(in a recent well-remembered crisis), and the House of 
Commons. Where our nursing interests are concerned, 
generous and ready aid is accorded us by Irishmen. 

United by such a bond, we can hope for eventual suc- 
cess; without combination we are powerless to forward 
any project. But above all does association help the 
nurse to cherish that sympathy which is so humanising 
and valuable to her of all people, for without some com- 
mon centre such as our association affords, each group of 
Matrons and nurses might continue to exist within their 
own perfectly organised hospitals and institutions, 
completely absorbed by their own rules and duties, 














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Great Britain and Ireland 113 

but it would be a narrowing process, and altogether 
lacking opportunities for that friendly comparison and 
emulation which are so helpful to Matron as well as 
nurse. 

From the association has now sprung the Dublin 
Nurses' Club, and a Nurses' Hostel, managed on co- 
operative prir ciples. The association and its policy 
are voiced in the Irish Trained Nurse and Hospital 
Review, whose, printed title is transfigured by the old 
Gaelic lettering, suggesting romance and poetry, 
and revival of the national spirit that indefinable 
spirit which gives each country its own personality 
and charm. The leaders of Irish nurses are alert and 
keen-eyed on public and political questions affecting 
the status and well-being of self-supporting women, 
and the spirit of the association as a whole is a free- 
dom-loving one, ready for self-defence at all points. 
Throughout the whole of the struggle of British 
nurses to obtain registration from Parliament, the 
Irish nurses have been keen and quick of action. At 
the time when, in 1908, through some obscure play 
of governmental politics, Irish nurses were threatened 
with exclusion from the registration bill then before 
Parliament, they uprose in vigorous resistance. 
Notable aid was brought to them then through the 
commanding ability of the late Lord Justice Fitz- 
Gibbon, and at all times they may count upon the 
chivalry of William Field, M.P., both in and out of 
Parliament. A visitor to Irish nursing circles is 
impressed by the atmosphere of brotherhood and 
equality between medical men and nurses and the 
generous attitude of the former toward the nurses' 
problems. Their spirit of liberality is shown in their 



VOL. III. 8 



ii4 A History of Nursing 

attitude when trained nursing was first introduced, 
which is in pleasing contrast to the story of some 
other countries. 

Irish nurses have often, doubtless, resented the 
encroachment of outside influence in hospital training 
and nursing affairs, when this influence is shown as an 
alien one, bent upon other policies than those believed 
by Irish women to be vital: How, indeed, could a 
people so high-spirited do other than resent this? 
But strangers who, coming sympathetically and with 
understanding, enter whole-heartedly into the prob- 
lems of training and association, nreet loyal com- 
radeship from the warm-hearted and democratic 
inhabitants of the Green Isle. 

If space allowed, it would be a pleasant task to list 
the noteworthy figures among the Dublin Matrons 
in the early part of the 2Oth century Miss Nora 
Cunningham, Gaelic Leaguer and Sinn Feiddhe and, 
like most of the group, a keen suffragist ; Miss Carson 
Rae, strong and staunch, advocate of special pre- 
liminary training in special colleges to fit young women 
to enter nursing, who brought about the affiliation 
of several hospitals in one training group; Miss 
Lamont, tactful Superintendent- General of the 
Queen's Nurses in Ireland; Miss Haughton, who was 
distinguished by being called back to Guy's, her 
alma mater, as Matron of that hospital in 1909; 
Miss Ramsden and Miss Reeves, also of the younger 
group; or the nurses, who, in off-duty time, sing the 
wailing songs of Ireland in soft moaning voices, or 
transform themselves with red petticoat and shawl 
into the bewitching, clog-dancing colleen. 

But we must turn for an instant from the city tc 



Great Britain and Ireland 115 

Ballincoona, in County Kerry, where the Hon. Al- 
binia Brodrick, trained nurse and midwife, writer, 
lecturer, and landed proprietor, effervescing with the 
wit and ge.iius of her race, is building a hospital 
which is to b e but the centre of a co-operative colony. 

I am told [>he says] that at a distance our hospital is 
known as The. White Elephant; we confidently expect to 
dispel this illusion. It is not simply a hospital; it is to 
be, please God, a centre for industrial and social develop- 
ment; our big hall will, I hope, be in frequent use for 
lectures, classes, and happy meetings. Like the old 
monks, we buiM in faith and await developments. 

Impending -political changes are likely to be re- 
flected in nurs\ig organisation in Great Britain and 
Ireland. Already the indications of new groupings 
are at hand as our chapter is completed, but the es- 
sential unity of the nursing sisterhood will remain 
unchanged and unspoiled. 



CHAPTER II 

THE GROWTH OF NURSING IN THE UNITED STATES 

First Steps. After the success of training schools 
had been proved, the pioneer institutions were called 
upon to send their graduates far and wide to initiate 
similar methods. The time between 1 1873 and 1895 
was a time of active renovation in hospitals. Within 
this period, in by far the majority of instances, the 
work of reconstruction was taken tip and carried to 
success by volunteer training-school committees, 
composed largely or entirely of women; over and 
over again, as in the case of the three first schools, 
they pushed their way in the face of opposition and | 
disbelief /* Although, in some instances, separate 
committees of women were dismissed with thanks 
by hospital directors as soon as their work was run- 
ning smoothly with value proved, yet such share as 
we see women taking in hospital management arose 
from the vantage-point gained by this demonstration. 
On general hospital boards, usually of the smaller or 
middle-sized institutions, they are sometimes found 
in positions of equality with men, sometimes holding 
auxiliary posts. But too few are the institutions 
of largest size where they occupy the place to which 
their early services entitled them. While it was 

116 



The United States 117 

natural that large hospitals should wish to bring 
their training schools under their centralised govern- 
ment, a broad and just policy would have invited 
to the directors' boards women whose training-school 
work had proved their administrative ability. On 
the whole, the steady general tendency has been for 
men to take control out of the women's hands. 

To follow the experiences of our pioneer nurses in 
hospital explorations is impossible. They found 
dirt and disorder to be almost universal. Vermin 
and infection were common even in pretentious 
buildings. Immorality was frequent. Coarseness 
and vulgarity they often met, and went well armed 
with moral force and intrepidity. Extraordinary 
customs and conditions existed. In one beautiful 
and wealthy hospital, the morgue table was used 
for operations, though Lister had announced his 
theories. In another, all the small rooms built for 
special free cases were filled with the mistresses of 
the city board of aldermen. Management was poor, 
often, even when good intentions prevailed; nurses' 
working hours were from four in the morning until 
ten at night, with resultant slovenliness of detail, 
and night duty was almost always so defectively 
organised as to be practically non-existent. The 
trained women who plunged into this public house- 
cleaning were so absorbed in it that to them, for a 
time, the outer world ceased to exist. It was quite 
as adventurous, quite as exacting, as war nursing. 
Nurses from different parts of the country met as 
veterans meet no other introduction necessary than 
their identity of experience. When order had been 
restored and time came for constructive work, they, 



n8 A History of Nursing 

with one accord, the country over, took up the pro- 
blem of giving their pupils ampler teaching and a 
more careful preparation than they themselves -fe^d 
had. It may be confidently asserted, that never in 
a modern country has a more disinterested and useful 
civic service been performed by women than this 
regeneration of hospitals by women's boards and 
nurses during the three last decades of the nineteenth 
century. In all estimates of the value of skilled 
nursing by women of education, only half the subject 
is considered if the immense moral uplift that they 
have given to institutions be forgotten or ignored. 

Gladly would we call a full roll of merit if space 
permitted, but at least those who first died in the 
service must be mentioned: Louise Darche, who, 
assisted by Diana C. Kimber, remodelled the training 
school on Blackwell's Island, in the hospital then 
named Charity, losing reason and life through the 
terrible struggle with the "spoils" system 1 ; Mary 
Rogers, who reformed the Children's Hospital in 
Washington, opened its training school, and affiliated 
it with that of the Columbia, this being the first in- 
stance of affiliation between two distinct groups of 
nurses for a more complete training; Lilla Lett, who 
laboured in St. Luke's, Chicago, and Florence 
Hutchinson, who followed her there, having first built 
up the school in the City Hospital of Indianapolis. 
All these women were Belle vue nurses, and, except 
Miss Rogers, all Canadians. 

Our pioneer authors, too, must be remembered: 
Harriet Camp (now Mrs. Lounsbery), then head of 

1 After Miss Darche's death Miss Kimber retired to England^ 
her native country, and entered an Anglican Sisterhood. 



The United States 119 

the Brooklyn school, wrote in 1889 the first book on 
ethics, called A Reference Book for Trained Nurses. 
Clara Weeks, a graduate of the New York Hospital, 
was the first American nurse to write a Textbook 
for Nurses a book which made her famous, and was 
never called by any name except her own. A Belle- 
vue nurse had the temerity to write the first hand- 
book for nurses on Materia Medica, and the first 
Anatomy and Physiology for Nurses was prepared 
by Miss Kimber. The first generation had felt 
keenly the want of suitable books of reference and 
spent its substance on ponderous and expensive 
medical works. Since their day, excellent technical 
manuals, written by nurses, have multiplied, the be- 
ginnings of a nursing literature have been made, and 
the senior trained nurse of America has crowned 
thirty-nine years of service by publishing her Rem- 
iniscences. 1 In 1886, the first professional journal 
of nursing made its appearance. It was a monthly, 
called The Nightingale, and was promoted and 
edited entirely by Sarah Post, M.D., a Belle vue 
nurse who had taken a medical degree. Not without 
opposition was it founded. Criticisms were pub- 
lished, pointing out that a magazine for nurses was 
"uncalled-for, improper, and capable of doing harm." 
(The Nightingale, February 15, 1888.) Neverthe- 
less, during the few years of its existence it main- 
tained an excellent standard of news and ethics and 
remains an interesting source of reference. 2 

The Nightingale records what was probably the 

1 Reminiscences of Linda Richards, Whitcomb and Barrows, 1911. 
3 It is now impossible to find a full file of The Nightingale. The 
of Medicine in New York has some copies. 



120 A History of Nursing 

first attempt made by American nurses to form an 
association: this was called the Philomena Society. 
The names of its founders have not been preserved, 
but it seems to have arisen in 1886-87 in New York, 
and to have died a natural death a year or so after- 
wards. Foundations for the first permanent union 
were laid in 1889, when a group of Bellevue graduates, 
meeting at the annual reception of the school, pro- 
posed to form an alumnae society. It was formally 
launched in April of that year, with a rigid and 
cramping constitution which, under a conservative 
president, hindered growth most effectually for 
some years, but was really not expressive of the will 
of the majority and was liberally amended and 
broadened in 1896-97. The next society of this kind 
was the alumnae group of the Illinois training 
school, founded in 1891, whose promoters had to 
combat the same difficult spirit of exclusiveness. 
The Johns Hopkins alumnae was formed in 1892; 
that of the Massachusetts General in 1895; f the 
Boston City in 1896; of the New England Hospital 
for Women and Children in 1898. These were the 
first. To-day, there is probably not a training school 
worthy the name that has not its society of alumnae. 
The attitude of aloofness at first maintained by train- 
ing schools towards one another was ludicrous, the 
clan spirit having been so sedulously fostered that it 
was almost held to be bad form for the pupils in one 
to know and visit those in another. In general, a 
dignified unconsciousness that there were any other 
hospitals than one's "own' was considered the cor- 
rect thing. It was a natural outcome of the highly 
military formal discipline imported from the old 



The United States 121 

world into the early schools, but as nurses began dis- 
covering one another in the world outside, they found 
that hospitals and the women in them were much 
alike, and the superciliousness arising from non- 
acquaintance faded away. Leaders in organisation 
combated vigorously the narrow point of view and 
vision fixed on self. Who has not heard the question : 
'What good will this society be to me?" " Little by 
little, through co-operation in work rather than by 
argument came the perception that the individual 
is best helped by that which raises and strengthens 
all. uThe fact that American nurses were thrown 
wholly upon their own resources after receiving their 
diplomas helped greatly to bring them into close 
fraternal relations and to promote their own in- 
dependent societies. They quickly realised the 
isolation and forlornity of lives cut off from the 
community, and understood that they must substi- 
tute another helpful mutual bond for that which 
they had left behind them in the hospital. 

Up to 1890, it may be said that the general tenor 
of nursing activities had been individualistic and 
intensely practical, while the ideal was expressed in 
work only. In that year, a new standard was set 
by the opening of the Johns Hopkins Hospital and 
Training School. The trustees of the hospital had 
determined to make it primarily a centre for liberal 
scientific teaching and a model of good methods 
in work. The entire administration was infused 
with this purpose, and the emphasis thus laid upon 
the intellectual side of hospital work, the definite 
assertion of a generous spirit of idealism, had a great, 
not easily estimated influence, radiating far and 



122 A History of Nursing 

wide, and greatly encouraging all those unnumbered 
silent workers who had been fulfilling their daily tasks 
in this spirit without meeting its full recognition. 
The opening of the training school was looked forward 
to by nurses with the greatest interest. Mr. King, 
then president of the trustees, went to England and 
had a two-hour interview with Miss Nightingale, 
who went over all the details of its organisation with 
him. To the faithful observance of her precepts 
must be ascribed much of the prestige which the 
school subsequently attained. 

Prominent nurses at home and abroad were in- 
terviewed, and the superintendency was offered to 
Isabel Hampton, then in charge of the Illinois train- 
ing school in Chicago. This appointment placed in 
a position of great advantage a woman whose influ- 
ence upon the education and general progress of 
nurses will long continue to be felt, and whose recent 
calamitous death justifies us in giving fuller detail 
to her life than might otherwise be possible. Isabel 
Adams Hampton was born in Welland, Canada, 
in 1860, and received a teacher's education in St. 
Catherine's. In 1881, she entered Bellevue for 
training, advised thereto by Miss Snively, as offering 
larger opportunities than teaching. For several 
years after graduation she held nursing appointments 
of a pioneer kind, one in St. Paul's House, Rome, 
for private duty among American patients. In 1888, 
she was selected by Miss Perkins to fill the vacant 
position of head of the Illinois school, which had 
called its first superintendent from Bellevue. She 
was then only twenty-six years old. There Miss 
Hampton made a reputation not only as an executive, 



The United States 123 

but as a teacher. She extended throughout the two 
years the class and lecture-room instruction, which 
had been limited, after the pattern of St. Thomas's, 
to one year. She stopped the custom of sending 
out undergraduates to private duty, and, to make 
good the experience with private patients thus lost, 
persuaded the managers to an arrangement by which 
they were made responsible for the nursing in the 
Presbyterian Hospital nearby. This was the first 
instance of one school nursing two unrelated hos- 
pitals, and endured until the growth of each neces- 
sitated a division and the Presbyterian developed its 
own training school. When Miss Hampton accepted 
the Baltimore position, she stipulated that her title 
should be, "Superintendent of Nurses and Principal 
of the Training School," in order to emphasise the 
educational idea. She went to the Johns Hopkins in 
May, 1889. 

A more splendid type of womanhood than Miss 
Hampton has not yet been pictured. Large and 
imposing, her figure built upon massive Greek lines, 
her features chiselled, her hand of unusual beauty, 
she was serene, gentle, and dignified in manner, her 
countenance illumined by a rich colour, large deep 
blue eyes that beamed with radiance, and a smile of 
winning sweetness. Her voice was one of her great 
charms, unusually soft and sweet, with an earnest 
thrill in it that, with her beaming eyes, expressed 
the eager intensity of enthusiasm and ardour for 
work and ideals which were most characteristic of 
her through life, and gave her what has been called 
her "gentle force." With great practical ability in 
details, Miss Hampton had a power of seeing the 



124 A History of Nursing 

future which was like that of a sibyl. . She had visions 
of nursing growth, organisation, and activities, which 
came first as hazy, indefinite pictures, gradually 
taking form until all was clear and vivid, filling her 
with joy and enthusiasm, eager interest, and untiring 
energy. By this impressionistic quality of her mind 
she forecast or perceived the goal that was to be 
reached and consciously wrought to reach it, where 
others, working from day to day, hardly realised 
whither they were tending. This power of seeing 
distant vistas of achievement, as one sees landscapes, 
made her companionship most stimulating and fasci- 
nating. Such was the woman, warm-hearted and 
responsive, simple and almost childlike in her direct- 
ness, having some faults of likes and dislikes and some 
imperfections as all must have, but filled with the 
highest belief in the mission of women as the superior 
moral force, and in the possibility of universal hap- 
piness, who became a beloved leader and held this 
place until her death. 

Having amplified and graded the course of instruc- 
tion through the two years, she then advocated and 
prepared the way for the three years' course and, as 
we shall see, thought out, proposed, and brought to 
pass the creation of a special course of higher instruc- 
tion at Teachers' College, for nurses intending to 
become teachers and administrators. Her first 
book was written at the Johns Hopkins. 

In organisation Miss Hampton's work was large 
and stimulating. The Johns Hopkins under her 
leadership was the first to set the example of an 
alumnae society into which each successive class of 
graduates entered as a group without exception. She 






Isabel Hampton Robb 

Taken when Superintendent of Nurses at the Johns H 




The United States 125 

had great visions of the mission of alumnae societies, 
and shaped the whole possible future of a national 
organisation long before it took form. The World's 
Fair year in Chicago, 1893, gave the opportunity 
for a national movement. Congresses were as numer- 
ous as blades of grass, and the association idea was 
in the air. In every line of interest and of work peo- 
ple from the four corners of the earth were coming 
together, and nurses shared in the stimulus. Mrs. 
Fenwick, then intensely absorbed in her great work 
of organisation in England, came to Chicago to 
arrange the English nursing exhibit sent from Great 
Britain to the Woman's Building. She inquired 
who were the American leaders in nursing, suggested 
to the Chicago women on the World's Fair boards 
the utility of a nursing congress, and came to Balti- 
more on her way home to visit Miss Hampton. 
Different as were these two in temperament, the 
one all lightning-like rapidity and fire, the other 
tranquil and serene, they were singularly alike in 
their enthusiasms, ideals, and professional demands. 
When the Congress of Hospitals and Dispensaries 
was finally promoted, with Dr. John S. Billings as 
chairman, a nursing section was arranged for and Dr. 
Billings offered its chairmanship to Miss Hampton. 
In the programme of this section, of which the 
arrangement was to her a devoutly serious piece of 
work, may be found the seedlings of almost all the 
later lines of growth in the nursing profession in the 
United States. Nor was it accidentally so, but the 
result of most earnest thought and divination. Often 
as she planned to whom certain themes should be 
given, did she describe the whole possible future that 



126 A History of Nursing 

might arise from the ideas she hoped to have brought 
out. In the main congress, Miss Hampton read her 
paper on the three years' and eight hours' course, 
in which she urged the possibility of the affiliation of 
varied institutions for the instruction of nurses. It 
was called ''Educational Standards for Nurses," 
and, at that time, she regarded it as the culmination 
of her teaching work. Miss Edith Draper, then 
superintendent of the Illinois school, had been given 
the subject, 'The Necessity for an American 
Nurses' Association." This was Miss Hampton's 
most cherished vision, and in her letters to Miss 
Draper, who was a close personal friend, she had 
poured forth her hopes about it. Miss Draper, how- 
ever, made her paper suggestive rather than construc- 
tive ; she spoke of the need of state associations and 
of a journal; she did not arrive at state registra- 
tion, but said: "A system of registering, (for a stand- 
ard of equality would be exacted) should be devised, 
so that all members of the association would be con- 
sidered equally competent as far as technical know- 
ledge went." Miss Alston, superintendent of the Mt. 
Sinai school, in New York, had a paper on the need 
for alumna? associations. In the discussion, Miss 
Hampton said: 'We must in time', evolve alumnas 
societies, an American association, and superintend- 
ents' conventions ; our meeting here is the first step ; 
before this congress adjourns we should have a meet- 
ing to form a society of superintendents of training 
schools." Miss Irene Sutliffe, then and long after, 
as head of the New York school, one of the most 
beloved of the early leaders, read a paper on the 
history of American nursing, in which she said: 



The United States 127 

"Would not a well regulated association of nurses 
do much toward correcting the danger of losing 
ideals?" 

When the congress was over, a committee chosen 
from the nurses present drafted a constitution and 
drew the lines for the American Society of Super- 
intendents of Training Schools for Nurses. It was 
formed in awful solemnity, and so all-important did 
certain doctrines of educational salvation appear 
to be, that all the women who were then engaged 
as heads of small or special hospitals, no matter 
how good their own training had been, were excluded 
from its select circle, nor did they dream of question- 
ing or murmuring at this decree. Though handi- 
capped thus by timidity at its outset, the society 
grew vigorously and, some few years later, discarded 
its artificial rules of membership and opened its 
doors to all women who themselves met the necessary 
standard. 

A pause may properly be made here to give this 
society a slight meed of the gratitude it so richly 
deserves from nurses. One who knew it for years 
in its most intimate relations can truly say that a 
more conscientious and high-minded group of women 
could not be found, or one more free from self-seeking. 
Their thought was ever how best to fulfil the three- 
fold obligation to the hospital, their pupils, and the 
public. There was no attempt to grasp at power for 
its own sake, but only to protect standards of work 
and ethics; no smallest desire to retain control over 
graduate nurses, but only to equip and prepare them 
for self-government. The occasional member whose 
outlook was small never rose to prominence, nor did 



128 A History of Nursing 

her views carry. An altruistic band of leaders and 
teachers, encouraging their alumnae groups to self- 
development, the superintendents' society has been 
almost self-effacing in the parent-like wish to bring 
its children forward, but wherever hard work even to 
drudgery was to be done in any good professional 
cause, its members have always been found at the 
front. 

Impossible as it is to mention all its most notable 
members, some of whom will appear as we go on, 
Miss Lucy Drown must be singled out for honours 
for her long years more than a quarter-century 
as superintendent of nurses in the Boston City 
school, and for her classic New England type: so 
high-minded, so scrupulously submissive where she 
thought her duty lay, so gentle, so immovable, with 
such an unexpected little flash of revolutionary 
spirit ! With her retirement went one of the cherished 
figures of her time. 

In February, 1896, it was felt that the time had come 
when the young alumnas societies might be united 
into one national body. A paper had been read at 
the Philadelphia meeting that winter, embodying 
Miss Hampton's vision of national union, and after- 
wards a committee was appointed to call together a 
convention to form a national association. 

The convention met in September, 1896, at the 
Manhattan Beach hotel, near New York, and was 
composed of delegates sent by alumnae societies, 
and of members of the superintendents' society, 
chosen and sent by that body. The name at first 
chosen was 'The Nurses' Associated Alumnse of 
the United States and Canada," but, with incorpora- 



The United States 129 

tion later, Canadian and American nurses had to 
organise separately, a thing they had at first been 
unwilling to do because of the strength of tie between 
those having the same alma mater. At this conven- 
tion, with Miss Hampton, then married to Dr. Robb, 
absent in Europe, much of the leadership was Miss 
Sophia Palmer's. She made the most practical 
suggestions, and caused the delegates to be formally 
voted in as charter members. The work of the 
convention was completed in February, 1897, in 
Baltimore. Mrs. Robb, radiant and beautiful, was 
then present and was elected president. Miss Wai- 
den from the New York alumnae, and Miss Ambrose, 
Presbyterian, first and second vice-presidents ; Miss 
Barnard, Johns Hopkins, secretary; and Miss Healy, 
Brooklyn City, treasurer. 

The associated alumnae also began in a timid way, 
with a certain amount of unf amiliarity with democra- 
tic principles. The first constitution was a cumber- 
some structure, providing for an elaborate machinery 
which never, in fact, materialised. Instead, a spon- 
taneous natural organisation went on swiftly, ignor- 
ing the constitution, which was presently amended 
to fit facts as they were. Another piece of useless 
trouble was taken over a code of ethics. A vast deal 
of seriousness was spent in poring, bewildered, over 
the Code of Ethics of the American Medical Associa- 
tion. The writer sought out Dr. John S. Billings in 
consultation, and recalls her shocked consternation 
when he said, in a dry, off-hand way, that the medical 
code had been the cause of untold wrangling in the 
medical profession. "Be good women," he added, 
' but do not have a code of ethics. ' ' This seemed like 

VOL. III. 9 



130 A History of Nursing 

blasphemy, but the ready-made ethical code was put 
aside by Mrs. Robb in her presidential remarks. 
The first annual convention was held in New York, 
in April, 1898, when Mrs. Robb gave a history of the 
formation of the society and told of the aspirations of 
the superintendents for their graduates, concluding 
with these words : 

With the presentation of this report ends their re- 
sponsibility toward this organisation, a responsibility so 
generously assumed by women, already crowded with 
work, in the best interests of the nursing profession in 
general and with absolutely no personal motives in view, 
other than the good that may come to them individually 
as members of their several societies. As one of their 
own members said in the discussion ' ' Superintendents 
will form a very small part of this organisation. It 
will be an association of independent women, who hope 
by uniting to work out many reforms." ... It seems 
like a brief dream as to time since that June of 1895, but 
a dreaming true as to results. So splendid have these 
results been thus far that I look forward into the future 
of the associated alumnae with joy and certainty that 
it will achieve greater and better things by nurses and 
for nurses than have ever yet come to pass. And with 
such a feeling and in such a spirit do I invite you to 
consideration of the work before us at this meeting. . . . 

A code of ethics is the first object mentioned in the 
constitution. But it cannot be among the first to be 
realised, for such a code should be the central point of 
thought of the association, reaching out in its inspiration 
and influence to our most remote branches, and toward 
which each individual member may look, vibrant with 
a sense of personal responsibility toward the association 
and toward the highest standard attainable by nurses. 



The United States 131 

It should stand for deeds and actions, not words and form. 
Were we, therefore, to appoint a committee to formulate 
forthwith a code of ethics, we should get words, but not 
the spirit. Surely, it will be better to wait until we have 
taken sufficient and better form in the matter of numbers 
and closer organisation, to learn the mind of the greater 
number of what shall constitute our national code of 
ethics, but I would like to say in passing that it should 
be founded, not on the lines of that of any existing as- 
sociation, but should be formulated to meet our own 
needs in our own particular way. . . . 

Growth of Education. The mechanical and un- 
satisfactory character of a bed limit in deciding the 
eligibility of women for the superintendents' society 
soon became clear to all, especially to those of high 
personal and professional attainments, who were un- 
selfishly devoting themselves to some obscure or 
struggling institution. The general feeling was 
voiced at the convention in 1897, by Mrs. Robb, in 
a thoughtful paper proposing individual qualifications 
for membership, and the affiliation of hospitals into 
training groups for bringing about greater uniformity, 
upon a broader basis, for the training of pupils. 
Following this, in 1898, she proposed trying to make 
use of Teachers College, connected with Columbia 
University in New York City, for giving nurses an 
advanced course in teaching and in administration. 
This idea had long been a cherished one with her. 
The writer well remembers how, years before, over 
the breakfast table or in quiet moments, it was set 
forth and dwelt upon with beaming eyes and the 
confident joyfulness of hope, though where it was to 
be fulfilled was not yet revealed. Following these 



132 A History of Nursing 

papers, Mrs. Robb was appointed chairman of the ed- 
ucational committee of the superintendents' society, 
and in this capacity visited Teachers College, saw 
Dean Russell to explain her ideas, and then, with 
Miss Nutting, Dean Russell, and Miss Kinne of the 
college, worked out a plan for the nurses' course. 1 
These steps, reported back to the society, were 
warmly endorsed, and Mrs. Robb was authorised to 
carry the plan through. Her first committee was 
composed of women who have built the beginnings 
of many important things: Miss M. E. P. Davis 
(then superintendent of the University hospital, 
Philadelphia), Miss Lucy Walker, an Irish woman 
and English-trained nurse (then superintendent of 
nurses at the Pennsylvania,) Miss Maud Banfield, an 
English woman, trained at St. Bartholomew's (then 
superintendent of the Poly clinic in Philadelphia), 
Miss Linda Richards, then beginning her remark- 
able work in the hospitals for the insane, and Miss 
M. Adelaide Nutting, the gifted Canadian, Mrs. 
Robb's pupil, who -fewd succeeded her at the Johns 
Hopkins. The committee was later enlarged, and 
has included many of our foremost superintendents. 
The two first pupils entered for the course, Miss 
Anna L. Alline and Miss Alice A. Gorman, both of 
whom had been at the head of training schools. 
The superintendents' society became responsible for 
funds needed for the new department of ' Hospital 
Economics"; subscriptions were readily promised 
by individuals and associations, while a spirit of 
zeal and exhilaration pervaded the nursing ranks. 
When finally launched the committee recommended 

1 Sixth Annual Report, American Society of Superintendents, p. 58, 



The United States 133 

that a nurse should be placed in charge of the class 
and course, and in 1901 Miss Alline consented to 
take the work at a purely nominal salary, because of 
her faith in it. For several years she practically gave 
herself to it, with great unselfishness, making it possi- 
ble for the early stage of growth to be safely passed. 
The professional lectures were given by nurses, heads 
of hospitals and training schools, often without 
payment. One course of special interest was that 
on the History of Hospitals and Nursing delivered 
by Miss Nutting. The syllabus of this course after- 
wards formed the framework of the published 
History of Nursing. A later pamphlet by Miss 
Nutting gives in a few words the basic idea of the 
plan for extended education at Teachers College. 
She says: 

The object of this course was to give some prepara- 
tion for the higher and more responsible positions in 
hospital work, as superintendents of hospitals or schools, 
and as teachers and instructors in various branches of 
nursing. The idea of establishing such a course was the 
outcome of years of continual effort to improve the 
education and training of nurses and to promote uniform- 
ity in curricula and in methods of teaching. It was 
clear that little improvement in methods of teaching 
could be hoped for until nurses had been taught how to 
teach. 

In 1904, an appeal was made for an endowment 
fund of 100,000 with an annual guarantee of $2500 
to pay instructors suitably. The need of an extension 
of the course to two years was also put forward. In 
1907, Miss Nutting was called from the Johns Hop- 



134 A History 6f Nursing 



kins training school, which she had directed with 
conspicuous ability since Miss Hampton's marriage, 
to Teachers College. Her work in developing the 
preliminary course of six months at the hospital had 
drawn the attention of educators to her and she was 
given a chair under the title of ' ' Institutional Man- 
agement," with the idea that students should be pre- 
pared to manage not only hospitals but institutions 
of all kinds, or homes, great and small. In 1909, 
on the advice of Miss Wald, a noble gift was made to 
the college by Mrs. Helen Hartley Jenkins, for the 
purpose of so extending the nurses' course as to add 
facilities for special training in all the new lines of 
social service. The practical side is to be developed 
through affiliation or co-operation with the settle- 
ments, the board of health, social and philanthropic 
foundations, and, in short, with all existing agencies 
of betterment. The full meaning of this most gen- 
erous and helpful gift may not be realised for some 
time to come. The title now given to the chair is 
" Nursing and Health." 

In the winter of 1910, Mrs. Robb's rich and fruitful 
life was instantly cut short by a most shocking acci- 
dent, and at their first subsequent meeting the nurses 
of the country testified to their devotion to her 
memory by founding the Isabel Hampton Robb 
Scholarship Fund for advanced study by nurses 
wherever they might best use it. As, without a 
doubt, for years to come at least, Teachers College 
will be selected by most of the beneficiaries, Isabel 
Robb's memory will be cherished long in the environs 
of the university where her vision was realised. 

Within the training schools the three-year course, 




M. Adelaide Nutting 

Professor of Nursing and Health, Teachers College. Taken when Superitfende 

of Nurses, Johns Hopkins Hospital 




The United States 133 

once started, made rapid progress, the eight hours 
lagging far behind. The Johns Hopkins, which loy- 
ally established both in, 1895 was not, however, the 
first with either one. It was found that the eight- 
hour day had been quietly put in force in 1891 at the 
Farrand training school in Detroit under the direc- 
tion of Mrs. Lystra E. Gretter, a Southern woman 
and leader in the Middle West, while the University 
hospital in Philadelphia was the first to respond to 
Miss Hampton's Chicago address and had begun the 
three years' schedule in 1894. At the seventh meet- 
ing of the superintendents' society fifty-five schools 
reported a three years' course established, and five 
more a course lengthened over the two years. That 
the three years is now the rule is shown by the Report 
of the United States Bureau of Education for 1908, 
giving the average training period of 1026 schools 
listed as two years and eight months. 

The preparatory course now found at the Johns 
Hopkins was Miss Nutting's contribution and was the 
first in this country. The need of preparatory teach- 
ing had been felt and talked of, and training school 
superintendents did much to bring about openings 
for special study for intending probationers in tech- 
nical institutes in Rochester and Boston. 

We have said that the eight-hour day lagged. 
Not yet have even the majority of hospitals granted 
the shorter day which was always regarded as a 
necessary part of the lengthened course, many, 
indeed, simply profited by the added utility without 
returning to the nurses any better facilities of teach- 
ing, experience, or administrative practice. Such 
instances might sometimes be explained by the re- 



136 A History of Nursing 

luctance of directors to begin an era of expansion 
where their staff was concerned, or by sheer inability 
to see the reason why: sometimes, too, by the fail- 
ure of the superintendent of nurses to carry off the 
honours of war. The foremost training schools 
developed advanced teaching in the third year, 
brought in social problems and subjects on the line 
of civics, gave practice in class teaching and hos- 
pital housekeeping, and, if no formal preparatory 
course was existent, arranged for the juniors courses 
in dietetics under domestic-science teachers, for which 
model diet kitchens were developed. 

The custom of sending out undergraduates to 
private duty was early discredited. From the first, 
American superintendents set their faces firmly 
against it, and alumnae societies have continued the 
policy of unqualified opposition to it. It is a purely 
sordid custom, unjust alike to the pupil, who loses 
the systematic instruction which she has a right to 
expect, to the patient, and to the graduate nurse 
trying to support herself. The argument of beneficial 
experience to the pupil sent to private cases is really 
a plea that the student can teach herself nursing, and 
yields the whole case to the correspondence schools, 

"> 

whose claim it also is that, with theoretical informa- 
tion given, the pupil can go into hornes and teach 
herself. The considerable sums of money earned 
for hospitals by this custom give it tenacity, and, 
even as late as 1911, it was estimated that about 
three hundred training schools in the United States 
sent pupils out to earn this money. These schools 
are not in the first, perhaps not even in the third, 
rank, but many of them will improve and rise to a 



The United States 137 

higher grade, when, we may hope, they will dis- 
continue this custom. 

In 1906, a medical panic, termed a "reaction," 
occurred in New York, and at a meeting at the Acad- 
emy of Medicine "The Overtrained Nurse" was dis- 
cussed. Several hospitals in that city, largely through 
the agitation of one anxious man, soon afterward 
returned to the two years' course. As at least two 
of these had never shortened their hours nor increased 
their instruction facilities, no great harm was done. 
Outside of New York the movement was regarded 
as retrograde and found no followers. It seems, 
indeed, to have had little basis except in the fear 
that the private-duty nurse might presently emerge 
as an independent practitioner. The chief thesis 
of the opposition actually took as its text a query 
found in a non-professional journal, viz., "Is nursing 
going to sever every connection with medicine and 
set up as an entirely separate science or art?' : Had 
this question been asked by a nurse in a journal edited 
and controlled by nurses, it might have been truly 
alarming, but, as the case stood, the panic seemed to 
have been groundless. No doubt the contention 
that nurses were too much stuffed with technical 
phraseology was true, and it is precisely for that 
reason that it is desirable to have nursing education 
regulated largely by nurses. Following the New 
York reaction, a number of weighty protests were 
made. The New York nurses and the superintend- 
ents of training schools offered resolutions deprecating 
a change backward; the New York City Visiting 
Committee of the State Charities Aid Association 
submitted a report in a letter addressed to the De- 



138 A History of Nursing 



partment of Public Charities in 1907, in which they 
upheld the three years but recommended shorter 
hours, good conditions, and a general, varied service 
(A. J. N., Feb., 1908). Dr. D. B. St. John Roosa of 
New York came out squarely in opposition to the back- 
ward step in an article written in 1908. The most ef- 
fective reinforcements were marshalled by Dr. Henry 
M. Kurd, then Superintendent of the Johns Hopkins 
hospital, who in the Hospital Superintendents' 
Association skilfully contrived to have a committee 
so composed that it could be relied upon to make 
a statesmanlike report, thus effectually disarming 
certain interests whose plan had been to have a 
report for lowered standards brought in. He also 
read a classic paper at the Canadian Hospital Super- 
intendents' meeting, in I9O8, 1 defending the highest 
standards, and pointing his moral by the tale of the 
young minister whose bishop knew him to be a 
second-rate man, but believed there were second-rate 
souls to be saved. The American Hospital Superin- 
tendents' Association Committee on Training Schools 
reported in 1909, in a broad, comprehensive, and 
liberal document, well presented and ably summed 
up. It did, in effect, simply record and endorse the 
best existing conditions, which had been brought 
into being chiefly by the labours of nurses as heads 
of training schools. One of these afterwards said, 
'It is mortifying that we have left it for the men 
to produce such a weighty report upon what the 
standards of our work should be." But the women 
had done, were doing, the work, without which the 

1 Reprinted in A. J. N., June, 1908, p. 671. 



The United States 139 

report could not have been. It was the work, not 
the report, which contained the living spark. 

On the whole, notable and high-minded support 
for good standards has usually come in times of stress 
from the medical profession. In 1906, the Phila- 
delphia County Medical Society, replying to a plea 
of the women in training-school work there (led by 
Miss Banfield), condemned correspondence schools 
of nursing or any form of training that dispensed 
with hospital training, and asked its members not to 
endorse such attempts. But our strongest allies are 
those in the educational field. The most advanced 
and gratifying stand yet possible has been taken 
by Dr. Richard Olding Beard of the Minnesota Uni- 
versity in his plans for the training of nurses, and his 
article, "The University Education of the Nurse," 
sounded like the realisation of a dream to Mrs. Robb 
and others when, in 1909, it was read at Minneapolis 
and London. In the early '90*5 the University of 
Texas first recognised nursing by giving a profes- 
sorial chair to the superintendent of nurses in the 
John Sealy Hospital of Galveston, then Miss Hanna 
Kindbom, a Swedish woman of character and ability. 
Her title was Professor of Nursing and she lectured 
to medical students as well as nurses. 

No one else, however, has taken so emphatic a 
stand as Prof. H. E. Mills, of Poughkeepsie, who 
resigned from the Board of Education in 191 1, rather 
than countenance the appointment of an incom- 
pletely-trained woman as public school nurse. 

Nursing the Insane .--The first steps toward 
bringing training into the hospitals for the insane 
were taken by Dr. Cowles, of the McLean Hospital 



140 A History of Nursing 

near Boston, and the medical directors of the state 
hospitals for the insane in New York. Dr. Cowles 
began as early as 1877 to bring trained nurses into 
the asylum from general hospital service, and from 
1880 to 1885 he worked toward the development of 
a school. This early experience, however, showed 
that the hospital trained nurse needed much addi- 
tional equipment before being fitted for the care of 
the insane. 

Between 1883 and 1893, a number of the state 
hospitals of New York established training schools, 
the first one being that of the Buffalo institution 
under Dr. Andrews. About 1896 a minimum stand- 
ard of teaching with uniform entrance and final 
examinations was adopted by all of the New York 
State hospitals for the insane: they, therefore, led 
the way to state examination, and perhaps because 
of this record the medical superintendents directing 
these vast establishments took a friendly and mag- 
nanimous attitude toward the later efforts of nurses 
for legal status, especially as they perceived that 
it must bring co-operation and a closer relation 
between the general and special hospitals. Each 
needs, for its nurses, what the other can give. The 
women who have given the most valuable service 
in adapting training-school methods to the work 
with the insane are Miss Mary E. May, Miss Linda 
Richards, and Miss Sara Parsons. The pioneer 
work has been most difficult, and the problem of 
obtaining the necessary numbers of desirable pro- 
bationers is, and will long remain, a vexing one, 
complicating every educational effort, and retarding, 
doubtless, the general advance. Yet the only real 



The United States 141 

solution lies in the slow uplifting of the whole mass 
by educational requirements which will slowly react 
on the e very-day family and individual. 

An Ethical Question- -The rapid multiplication 
of training schools during a couple of decades should 
soon slow down to a more moderate pace. 1 Then 
the first growth made, an era of structural improve- 
ment should follow. The remark of a member of a 
state examining board, that 'the multiplicity of 
small hospitals owned by medical men, where train- 
ing schools are maintained for strictly commercial 
purposes, is the greatest problem that confronts us," 
gives room for wonder whether it is not time for the 
medical profession to add a new article to its code of 
ethics, to the effect, namely, that private speculation 
in nursing education more or less bogus should be 
considered as no more honourable than the same 
traffic in medical education. In every one of the 
little private hospitals of the medical men, good 
nurses are needed, but they should be trained co- 
operatively, with a view to the public good, not 
sweated for private individual profit. 2 

1 The United States Bureau of Education for 1909 has the following: 
Training Schools Pupils 



1880 15 

I8 9 35 Men 

1900 432 and 



323 
i,552 
11,164 
21,119 

1908 1,026 26,457 

1909 1,096 - 29,320 
These figures include hospitals for the insane where training schools 

have been opened. The number of schools in general hospitals, 1909, 
is given as 1006. 

2 A report from a private hospital owned by a medical man 
showed a "training school" of sixteen nurses. No teaching was 



142 A History of Nursing 

STATE REGISTRATION 

We have seen that English nurses led by Mrs. 
Fen wick awoke before Americans to the need of 
legal status, because the economic pressure was felt 
more acutely by them. Upon the kind and effective- 
ness of the education one receives depend the work- 
ing efficiency and, largely, the social usefulness of 
the individual also ability to meet opportunity and 
to maintain a good standard of living. While state 
protection of the nurse's training is, at top, an edu- 
cational, it is at bottom an economic, question. 
Nurses as a whole, however, were long unconscious 
of this close relationship, and Americans, with their 
more abounding opportunities, came more slowly 
to realise it. When, in June, 1899, at the London 
Congress, Mrs. Fen wick said to the writer: "Why do 
not the American nurses go in for state registration? ' 
the words fell on unheeding ears. There had been 
many others, however, who, solely from the educa- 
tional standpoint, had long been anxious and watch- 
ful by reason of the rapid increase of training schools 
and the resultant dilution of ideals. Many were the 
individual nurses who, disturbed by the tendencies 
they perceived, said vaguely now and again: "There 
ought to be a law against" this and that. This 
undercurrent was later voiced and its significance 
in bringing organisation to pass expressed by Isabel 
Hampton Robb, in 1899, when, as president of the 
second annual convention, she said: 

allowed; the nurses did all the servants' work, including their own 
ironing; even a monthly allowance was not given on ground of the 
"diploma." A. J. N. t May, 1903, p. 627. 



The United States 143 

After the first few years, when graduates began to 
increase in number and the value of their work had been 
manifest in hospital and home, we find more branches 
beginning to shoot out, and more training schools spring- 
ing into existence. In the past ten years, more especially, 
there has been a not altogether healthy overgrowth. 
The increase has been almost alarming, and there are 
now to be found all sorts and conditions of hospitals and 
training schools, with the result that the country has 
been flooded with a very nondescript class of women all 
bearing the title of trained nurse, the term standing for 
all grades of training and all grades of women. As a 
natural consequence the public has freely offered its 
criticisms. Here then was the first problem to confront 
us, the rapid increase in quantity without a correspond- 
ing improvement in quality, and as this discrepancy 
became more and more apparent, the older and better- 
known schools, with the instinct of self-preservation, 
began to draw more closely within themselves, trusting 
in their own irreproachable names to protect their gradu- 
ates, with the result that the members of one school 
were led to hold themselves severely aloof from those of 
another. Fortunately this narrow and selfish policy 
could not last long. Gradually but forcibly it was borne 
in upon the minds of the older and more experienced that 
in this way did not lie success and advancement, that 
nurses could not afford to be narrow and self-seeking, 
and that to attain to a fixed high standard in our work, 
to overcome the evils that were increasing, and to collect 
our scattered forces, we must have unity of purpose and 
centralisation of means. 

The first definite steps looking toward state re- 
gistration were taken almost simultaneously, yet 
quite independently, by Miss Sophia F. Palmer, head 



144 A History of Nursing 

of the City hospital in Rochester, and Miss Sylveen 
Nye, who, in Buffalo, had organised a nurses' 
club out of very diverse and isolated elements. In 
Buffalo, too, was Miss Annie Darner, who afterwards 
took a leading part in national organisation. It 
would perhaps be impossible to say to whom the 
credit of the first thought is due, but the first one of 
the series of steps leading to the final result was the 
paper read by Miss Palmer before the State Federa- 
tion of Women's Clubs on November 9, 1899. In 
this paper she said: 

The greatest need in the nursing profession to-day 
is a law that shall place training schools for nurses under 
the supervision of the University of the State of New 
York. Such a law would require every training school to 
bring its standard up to a given point, . . . would require 
every woman who wished to practise nursing to obtain a 
diploma from a training school recognised by the Univer- 
sity, to pass a Regents' examination, and to register her 
licence to practise. ... It is of vital importance that 
examining boards shall be selected from among nurses in 
practically the same manner that medical boards are 
chosen from physicians, that pharmacists, dentists, and 
teachers are examined, each by members of their own 
profession. 

At the same meeting Miss Eva Allerton, afterwards 
distinguished by her brilliant work in guiding the 
nurses' act to success, explained the functions of 
the Regents. 1 

1 "The University of the State of New York controls, so to speak, 
the output of 668 institutions of learning in the state academies, 
colleges, universities, professional and technical schools, but does 
not include schools of nursing. It registers educational plants all 



The United States 145 

As a result of these papers, the Federation of 
Women's Clubs passed a resolution endorsing the 
formation of a board of examiners chosen by a state 
society of nurses and recommending the inclusion of 
nursing education in the list of professions supervised 
by the Regents. Before reading her paper, Miss 
Palmer asked Dr. William S. Ely, of Rochester, what 
he thought of her suggestion, and he was delighted 
with it, wondering why no one had thought of it be- 
fore. He was especially cordial toward the idea that, 
if put into operation, it must be under a board of 
nurse examiners. Curiously enough, at about the 
same time, Miss Nye suggested her ideas to Dr. 
Charles S. Butler, of Buffalo, and both Dr. Butler and 
Dr. Ely, writing to the Regents' office to advance the 
project, received replies at the same time, from Mr. 
Parsons, then Director under the Regents. These 
replies showed very careful thought on Mr. Parsons' 
part, and an application of the principles govern- 
ing the other professions to that of nursing. On 
November i6th, Miss Palmer telegraphed to Mr. 
Parsons to ask him to receive a delegation of 
nurses to talk the matter over, and the conference 
took place on the i8th, with Miss Palmer, Miss 
Allerton, and Mrs. Robb present. They had just 
come from New York, where Mrs. Robb had pro- 
posed Miss Palmer's name as editor of the American 
Journal of Nursing, then being planned for. So 
was legal status for nurses initiated in the United 

over the world. It is governed and all its corporate powers are ex- 
ercised by nineteen elective Regents, who are elected in the same 
manner as United States Senators, but for life. They serve without 
salary, thus taking the matter out of politics. . . ." 



VOL. III. 10. 



146 A History of Nursing 

States. Because of the standing of the Regents of 
New York, the importance of the state as a nursing 
centre, and the novelty of the idea of a board of 
examiners composed wholly of nurses, it seems 
proper to give some space to the details of this 
undertaking. 

At the third annual convention in 1900, the need 
of broader, more elastic associations was felt in the 
air. Expanding growth and individual activity 
were again recorded by Mrs. Robb in her presidential 
address, as she summed up the important things 
before the nursing profession at that moment. 

. . . we trust steps may soon be taken to form state 
associations, beginning in all probability with New 
York. As many of us know, the question of registration 
for trained nurses has been long in our minds, but we 
were also aware that to advocate legislation eight or ten 
years ago would have been to put the cart before the 
horse. . . . The fulness of time brings us to the vital 
question of registration for nurses only so will it be pos- 
sible for trained nursing to attain its full dignity as a 
recognised profession and obtain permanent reforms. . . . 
As regards the schools, the introduction of a legalised 
registration would naturally stimulate both schools and 
graduates to reach the required standard. ... If we do 
not take care of our own affairs, rest assured that out- 
siders will undertake the task for us, to our everlasting 
undoing and to the detriment of the public, to whose 
sick we have the privilege of ministering. . . . Can we 
be still and let things just take their own way, as long 
as the stamp of mediocrity marks a work to which 
should be given the best and highest that the hands, 
hearts, and minds of women can bring? This is no work 
that can be taken up lightly or laid aside carelessly by 



The United States 147 

the first comer, but one chat should be entrusted only 
to women, each one of whom should be ordained a 
priestess, as it were, before she presumes to enter the 
temple to perform her ministries unto sick and suffering 
humanity. 

The force of democratic tendencies was next voiced 
by Miss Darner, who said: "The Buffalo Nurses' 
Association organised five years ago, taking in all 
graduate nurses in the city, from small and large 
schools. . . . We feel the necessity of state organi- 
sation for legislative purposes; we think the state 
association should be an independent body, but 
affiliated with the national. ..." In the discussion 
Miss Palmer, whose ideas of legislation were fully 
matured and definite, said: 

When we come to organise a state society, the princi- 
pal motive being to influence legislation, we take an 
entirely new departure from the motives actuating us in 
upbuilding our associations for educational and social 
purposes. We go before the legislature, not as gradu- 
ates of any one school, but as citizens of the state. . . . 
In regard to the county society we have organised in 
Rochester and I think we are the pioneers in county 
societies our principal motive has been to assist in the 
formation of a state society. 

At the end of this meeting a conference was held at 
the Presbyterian training school to consider ways and 
means in founding a state society. The movement 
thus begun was to sweep successfully from east to 
west, but New York, the leader, did not first win her 
legal status. 

New York. A general call to the nurses all over 



148 A History of Nursing 

the state went forth on February 26, 1901, and or- 
ganisation, quickly effected, was followed by intense 
activity and concentration upon legislative work. 
Instantly there stood forth two opposing standard- 
bearers, and a duel typically illustrative of all subse- 
quent struggles began. The first president of the state 
association, a strong, capable, and earnest woman, 
well deserved the position by reason of her arduous 
work. Her belief, however, was that, in organisation 
and legislation, as well as in the sick-room, nurses 
should be subordinate to medical associates. The 
first rounds of the duel were, therefore, upon the 
composition of the society and its officers. z Around 
the one word 'nurses' 1 went on a lively contest. 
The determination of the majority, to avoid all en- 
tangling alliances and to restrict membership to 
nurses, became clear. On the floor of the legislature 
the duel recommenced. There appeared the com- 
mercial man, and the one who curried political 
favour. The chairman of the nurses' legislative 
committee was Miss Eva Allerton, a Massachusetts 
General graduate and head of a Rochester hospital, 
the Homeopathic, a woman of the utmost ability and 
remarkable magnetism, whose exertions and great 
responsibilities in this legislative campaign no doubt 
hastened her premature and lamented death. As- 
sociated with her was Miss Palmer, whose strong 
will and forceful character braced other, less con- 
fident, fighters, and Father Hendricks, at that time 

1 See paper on "Organisation and Registration," by Sylveen 
Nye, Transactions, International Congress of Nurses, Buffalo, 1901, 
P- 343> et seq., and, in connection with it, read preceding paper by 
Mrs. Bedford Fenwick. 



The United States 149 

one of the Regents. The support he gave the 
nurses was strong and splendid. He was fore- 
most among the men who helped them, and his 
later mission to the Philippines was the loss of the 
nursing profession in New York State. Senator 
Armstrong and Assemblyman Davis, by wise man- 
agement, made the bill a non-partisan measure. It 
received the active support of the whole nursing 
profession (except that small group, which stood 
for medical members on examining boards), of 
public-spirited laymen and women, such as those on 
hospital boards, and of the Catholic nursing orders of 
the state. Nurses everywhere besieged their repre- 
sentatives, and one who happened to be caring 
for a case in the governor's family, stopped him 
on the stairs and obtained his promise to sign the 
nurses' bill, if it passed. Besides all this, we shall 
probably never know just how much we owe to Mrs. 
Whitelaw Reid, who quietly used her very great 
influence with public men in its behalf. Never- 
theless, it was tenaciously contested. It was a new 
thing to see women coming forward, nurses at that, 
demanding the same guarantees which had been 
granted to the medical, dental, and other professions, 
and to skilled callings, such as that of the plumber, 
engineer, and horseshoer. Would they get out of 
hand? Where would it stop? The New York 
County Medical Society, which had previously 
endorsed the bill by resolution, sent its legal counsel, 
Mr. Andrews, and the chairman of its legislative 
committee, Dr. Frank Van Fleet, to Albany to sup- 
port it, but they were charged to see that, if possible, 
medical men were placed on the examining board. 



150 A History of Nursing 

When, however, the character of the opposition 
became plain, these two chivalrously entered the 
lists in the nurses' behalf. The hostile forces centred 
in Albany, and four nurses sat with them at the hear- 
ings; one of them, be it confessed, a training-school 
superintendent. The attack concentrated on the 
provision creating a board of nurse examiners nomi- 
nated by the nurses' society and appointed by the 
Regents, while the defence was that nurses could 
not come up for examination without having come 
under the teaching and supervision of physicians; 
that they could not receive their diplomas without 
medical approval ; that as three of the Regents were 
physicians the medical element was thus sufficiently 
represented ; and, finally, that the nursing profession 
desired to keep clear of medical politics, which was 
evident in the friction between the three schools of 
medicine recognised by the state (regular, homeo- 
pathic, and eclectic), as the differences in medicine 
were outside of nursing cognisance and nurses had 
no intention of being drawn into them. As a last 
attack a bill was introduced by Assemblyman Nye 
asking for registration under the Secretary of State, 
without any educational standards whatever. Dr. 
Frank Van Fleet, Dr. William S. Ely, Dr. Hartman, 
and others spoke strongly and well in favour of leav- 
ing the nurses to manage their own educational 
affairs, while effective support was given by the 
speeches of Miss Margaret Dreier, Mrs. Francis 
Scott, Mrs. Cadwalader Jones, all of whom were 
prominent on training-school boards, and Mrs. 
Montgomery of Rochester. 

The nurses secured their own board of examiners 



The United States 151 

and the equally important detail of the right of nom- 
ination by their state society for these positions. 
This is the keystone and safeguard against political 
machination. From the list of nominees the Regents 
select five. There is nothing to prevent physicians 
from being nominated, as both men and women 
nurses have studied medicine, and such nominations 
have been made. Applicants must be over twenty- 
one and possess a diploma from a training school 
connected with a hospital or sanitarium giving at 
least two years' training, and registered by the 
Regents as maintaining in this and other respects 
proper standards, all of which shall be determined 
by the Regents. In order to determine standards, 
the Regents have their inspectors. The very moder- 
ate demands of the New York bill count for more 
than shows at first glance because of the powers of 
the Regents. 

The examining board was instructed to decide the 
minimum of practical and theoretical work that 
should justify recognition by the state, and to send a 
syllabus to training schools. In addition to the four 
regular branches (medical, surgical, gynecological 
and obstetrical nursing), special emphasis was laid 
on dietetics, the management of contagions, and the 
care of sick children, while private duty was limited 
to the last three months of a three-years' course. 

In the winter of 1905-6 an attempt was made to 
amend injuriously the New York act; a bill was in- 
troduced by one Cooper to repeal the existing law 
and substitute a "nursing commission" composed 
of physicians who were to draw high salaries for 
their services. The attempt was defeated, a strong 



152 A History of Nursing 

delegation of nurses and medical superintendents 
of hospitals appearing against it. Its promoters 
promised to come back every year until they gained 
their purpose, claiming that their action was in the 
interests of nurses. Following this, an attempt was 
made to abolish the board of nurse examiners and 
substitute a board composed of medical men. This 
also failed. In April, 1911, the act was again threat- 
ened by harmful amendments which were success- 
fully warded off by the state society. Back of these 
attacks were dissatisfied medical men interested in 
small hospitals. In June of that year the nurses' 
legislative committee was enlarged, and met the 
dissatisfied medical delegates in conference. It was 
agreed that methods of administration might relieve 
the tension, and a truce was declared. In 1912, 
nurses were astonished by a set of resolutions adopted 
by the men directing the large hospitals in New York, 
which, in effect, demanded the practical nullification 
of the whole educational structure of the act. It is 
possible that when this History appears, our poor 
little provision of one year in high school may have 
been swept away as an intolerable restriction. * 

Important incidents in the history of the act have 
been the appointment of a nurse as inspector of 
training schools in 1906, and the later formation of a 
committee of nurses from the state society and their 
inclusion on the Regents' Advisory Council, which is 
composed of the deans of professional schools. The 
first nurse inspector was Miss Alline. She was 
followed three years later by Miss Annie W. Good- 
rich, one of the younger superintendents. A New 

1 See A. J. N., April and May, 1912, Editorials. 



The United States 153 

England woman of high type, Miss Goodrich had 
been called successively to four of the most important 
hospitals in New York City, one of which was her 
own alma mater, the New York and the last, Belle- 
vue, where, as General Superintendent of Train- 
ing Schools of Bellevue and Allied Hospitals, she 
held a unique position. In organisation work she is 
also prominent, and was president of the American 
nurses' delegation to the London Congress in 1909. 

North Carolina.- -The first of all to carry a bill 
through was North Carolina. The state society 
was formed in 1902, and its bill presented a little 
over a year later. There was some opposition from 
several physicians, but "only on general principles" 
as they explained. The nurses, however, agreed to 
a mixed board, composed of three nurses, appointed 
by the state society, and two physicians appointed 
by the state medical society. Those chiefly instru- 
mental in securing the bill's passage were Miss Mary 
L. Wyche, and Dr. Richard Lewis, a specially staunch 
friend. The first requirements of the bill were very 
slight. For one year no time of training was specified, 
but a diploma from any reputable general hospital, 
either public or private, or from a hospital for the 
insane, admitted its holder to registration. After a 
year the board was to examine applicants in eight 
subjects, but still no time for training was specified. 
But in 1907, North Carolina secured amendments 
raising the entrance requirement to a high-school 
education and fixing the training at three years of 
systematic instruction in a hospital or sanitarium. 
As there are no large hospitals in North Carolina, 
this advanced step is all the more creditable. In the 



154 A History of Nursing 

same year, Miss Wyche, still active as a superintend- 
ent of nurses and member of the state society, 
wrote an admirable letter to the president of the 
State Normal and Industrial College at Greensboro, 
asking for a thorough-going course of preliminary 
study to last nine months and give anatomy and 
physiology, personal and household hygiene, eco- 
nomic and domestic science and dietetics, elementary 
biology and chemistry, physical culture and class- 
room demonstration in practical work, with lectures 
and reading courses ; the whole to count for six months 
in a course of three years. This will no doubt come 
before long. 

New Jersey. New Jersey gained a registration 
act in the same year and month, but a little before 
that of New York. It was, however, scarred by 
battle and by treachery. New Jersey was unfortun- 
ate in having as a near neighbour one of the most 
powerful and active of corporations that have in- 
vented their own methods of teaching nurses. After 
a desperate struggle the nurses lost the examining 
board, a licence to practice 'the profession of a 
graduate nurse " being given by the clerk of the 
county on presentation of a diploma awarded by a 
training school connected with a hospital of the 
state where at least two years practical and theo- 
retical training were required before graduation. The 
society, however, rightly felt that it had gained a 
point against great odds in securing the requirement 
of a two-years' hospital course with theoretical and 
practical training. The words "of the state' pro- 
tected against correspondence schools outside, and 
the influence of the New York requirements, with 



The United States 155 

the Regents' registration of training schools, helped 
to counteract the discouraging effect of the New 
Jersey law. The American Journal of Nursing said 
of the contest there: 

No other state found its movement for registration so 
bitterly and so formidably opposed. Through the in- 
fluence of a Philadelphia organisation, the New Jersey 
papers not only gave the nurses no support, but vilified 
their movement. The Philadelphia papers also gave col- 
umns to abuse of the nurses and glorification of a short- 
term course in which the pupils practised on the poor. 
The nurses' statements of their position were returned as 
'not wanted.' The Philadelphia Medical Journal alone 
supported the bill. The medical profession in New 
Jersey was silenced, and although the state medical 
society had endorsed the nurses' bill, a member of its 
legislative committee lobbied in opposition and circulated 
pamphlets among the legislators, setting forth the advan- 
tages of short training and urging defeat of the measure. 

Yet there were some cheering incidents even in New 
Jersey. Lay champions were not wanting who were 
valiant and loyal. After the bill had been passed 
the rumour was heard that the governor was being 
pressed to veto it. A nurse, who, by her services to 
a patient had gained the gratitude of a prominent 
man, hastened to him with the bad news: "Oh, Judge 

,the governor is going to veto our bill." " H'm ! 

Going to veto it, is he? He '11 sign it if I have to 
stand over him with a gun." The bill was signed. 

In 1911, the New Jersey nurses rallied and set 
to work to improve their badly-treated act. After 
a hard winter's work they succeeded in pushing an 
amended bill through the house, only to have it 



156 A History of Nursing 

lost in the senate. In 1912, they were finally suc- 
cessful, and secured an examining board of nurses, 
and a requirement of one year in high school. 

Virginia. Organised a state society in 1901, its 
moving spirit and first, now honorary, president, 
being Miss Cabaniss, a Virginia woman of noble 
heritage of character and intellect. The Virginia 
bill was introduced in 1903, and had an exciting 
career. For a time it was seriously threatened, not on 
any definite grounds, but simply by 'cranky M.D's 
and young, ill-informed delegates to the state leg- 
islature." By the latter it was vehemently de- 
nounced as a ' Trust ?: and a 'First Step toward 
Woman Suffrage." Violent opposition of this kind 
was gradually subdued by tactful handling and good 
lobbying, and by the opportune appearance of forty- 
odd nurses upon the floor, when a chivalrous member 
declared: "I have met the enemy and I am theirs," 
and the victory was won. The bill was signed in 
May, 1903, and has never been attacked or weak- 
ened. It gives a board of nurse examiners, nomin- 
ated by the state society and appointed by the 
governor; requires a training of at least two years, 
with general instruction, in the wards of a general 
hospital, and leaves the preliminary education and 
the standards to be required from training school 
and hospital to be fixed by the board. After one year 
of grace, Virginia made it unlawful to practise pro- 
fessional nursing without a licence, but this did not 
apply to women earning their living as nurses who 
did not assume to be trained. This was the first 
example of a mandatory act. The Virginia act has 
been administered with wisdom and patience, re- 



The United States 157 

suiting in steady educational progress. Those es- 
pecially deserving of honours for work in its behalf 
were Dr. George Ben Johnston and Dr. William S. 
Gordon; Jean Macara Glasgow, a married nurse, 
and her husband, a lawyer, who freely gave invalu- 
able services, while among the nurses those of the 
Old Dominion and the Nurses' Settlement were 
untiring. 

Maryland came next. Her state society was or- 
ganised in 1903 and a bill presented to the legisla- 
ture and passed without injurious amendments in the 
same session. The striking efficiency of the Mary- 
land state society, then as afterwards, was a testi- 
monial to the great energy and high aims of Miss 
Nutting, its organiser arid first president, and her 
co-workers, and the act showed the good influence 
of the Johns Hopkins hospital. A whole-hearted 
support was given by the nurses and the medical 
profession, opposition only coming from one source, 
a small hospital whose directors wished to send their 
pupils to private duty for the gain of their fees. They 
were defeated. The nurses obtained an examining 
board appointed by the governor from names 
nominated by the state society, fixed the age of ap- 
plicants at twenty-three years, and set an entrance 
requirement of high-school education, and a three- 
years' training in one general hospital, or in two 
or more under the direction of a central school. 
(This provision is intended to facilitate the affiliation 
of several hospitals for purposes of training.) 

The stand taken by medical men of the highest 
rank is illustrated by remarks made by Dr. William 
Welch at one of the meetings: 



158 A History of Nursing 

You have to consider exactly how to proceed to 
secure the state examining board. I noticed that in 
several of the states the law was almost imperilled by 
efforts to secure the presence of physicians upon these 
examining boards. Now I am quite sure that it is not 
the function of the physician to examine the nurses. 
The nurse should not go forth without having come under 
the guidance of the physician, but your profession is a 
skilled profession which requires special knowledge pos- 
sessed by the trained nurse and not by the physician. 
Akin as the professions of medicine and nursing are, 
they are still distinct professions, and there is no necessity, 
in my opinion, and there are certain disadvantages, 
in the requirement that physicians should be members 
of the nurses' examining board. 

In 1906, an attempt was made to secure an amend- 
ment aiming at lower standards which would permit 
the exploitation of pupils, but it was promptly met 
by the state society and defeated. After the act 
went into effect Miss Georgina Ross, then Miss 
Nutting's assistant, and one of the most practical 
and efficient of women, was asked by the state society 
to undertake an inspection of schools, and, so accept- 
ably did she fill this unofficial role that an agreement 
was arrived at among the hospitals of the state by 
which a uniform minimum of training was arranged 
for the junior year. 

Four states, Indiana, California, Colorado, and 
Connecticut, passed registration acts in 1905. 

Indiana. The nurses' state society was formed in 
1903. When its bill was introduced two years later, 
open opposition came only from one, the Epworth 
hospital, which took the stand that there was no 



The United States 159 

need for registration. The bill granted a full board 
of nurses appointed by the governor, though it did 
not say that the state society should nominate. The 
requirements were: the equivalent of a high-school 
education, twenty-one years of age, and a course of 
two years with systematic teaching in a general 
hospital approved by the examining board. The 
practice of nursing without registration was forbidden 
to all who assumed to be trained. Special recogni- 
tion for loyal and hard work is due to Dr. W. H. 
Wishard, Mr. William Bosson, who framed the bill, 
Dr. Maude McConnell, who is both nurse and phys- 
ician, and Mrs. Sarah Belk Brown, who carried the 
great mass of details of all kinds. In 1906, a nurse 
inspector of training schools was appointed, who 
visited every hospital in the state. In 1907, through 
the influence of the Lutheran hospital of Fort Wayne, 
an injurious amendment, lowering the educational 
standard set by the act from a high-school to a 
grammar-school requirement, was successfully pushed 
through the legislature. To offset this the nurses' 
board prepared a uniform curriculum for training 
schools, which was issued in January, 1907. 

California. Many troubles attended the registra- 
tion work in this state. The nurses formed their 
society in 1903, and brought a bill to the legislature 
in 1905, asking for the usual board of nurses. Learn- 
ing that the governor disapproved of administrative 
boards, they altered their request and made the 
Regents of the University of California their trustees. 
The bill was passed that year, but then treason in 
the ranks showed forth: several nurses, members 
of the association, who had attended meetings and 



160 A History of Nursing 

given no sign of their intent, swiftly launched an 
opposition bill of lower educational requirements. 
Though this died in committee, its sponsor succeeded 
in amending the original bill from a high-school to 
grammar-school standard, and in reducing the age 
of applicants from twenty-one to eighteen years. An 
unexpected difficulty now arose in the unwillingness 
of the Regents to administer the law, though Presi- 
dent Wheeler of the university approved of doing 
so. However, a new governor recommended that 
the Regents take up the bill. They did so, and 
appointed an examining board of five nurses and 
two physicians, the names of the former being sug- 
gested by the state association. The delay had 
been so protracted that the time of grace had then 
elapsed, and fresh legislative action will be necessary 
before the machinery of the law can be set in motion. 
A feature of the campaign was the excellent organi- 
sation of nurses throughout the state, and with the 
recent woman-suffrage victory progress in nursing 
affairs may be expected. Many physicians lent 
loyal support, especially Dr. Charles D. Lockwood 
and Dr. H. G. Brainerd, and among the many 
nurses may be especially mentioned the work of 
Miss Theresa McCarthy, Miss Genevieve Cooke, 
Miss Sophie G. Rutley, Mrs. C. D. Lockwood, and 
Dr. Helen Criswell. 

Colorado formed a state society in 1904. In 1905, 
a registration bill was presented to the legislature, 
passing in the same year, without difficulty and al- 
most without opposition, except from "the man who 
had a training school in Pueblo, who knew how to 
train nurses in six weeks." Though the doctors 



The United States 161 

helped very little, they made no objections and the 
unamended bill was signed in April. The nurses had 
reason to feel that they were treated with great con- 
sideration by the lawmakers, as a gubernatorial con- 
test was in progress, which took just one-half of the 
legislative hours, and caused many bills to die un- 
noticed. An interesting feature of the campaign was 
that the chairman of the senate committee was a 
Christian Scientist, yet his committee voted unani- 
mously to report the bill favourably. A full nurses' 
board was granted, appointed by the governor, but 
not nominated by the society. Members of the board 
must have had a three years' course in a general 
hospital or sanitarium giving a systematic training. 
Requirements for examination obliged applicants 
to show diplomas from such hospitals as have a 
standard of instruction and training conforming to 
the rules prescribed by the nurses' board. The law 
also provided that after 1906 "it shall be unlawful 
for any person to practise nursing as a trained, 
graduate, or registered nurse without a certificate 
from the board of examiners." Those who do not 
call themselves trained are allowed to practise with- 
out interference as untrained or simply experienced 
women. The nurses did good campaign work, Miss 
Louie Croft Boyd carrying off chief honours, t 

Connecticut organised a state society in 1904 and 
presented a bill in 1905. It met with strong opposi- 
tion from physicians who were conducting training 
schools in small sanatoria, but in spite of this it passed 
in the same year with no injurious amendments, a 
tribute to the effective work of the nurses, who 
were staunch and solid in its support. Especially 



VOL. in. n 



162 A History of Nursing 

deserving of laurels were Miss Charlotte Brown, Miss 
Mary Gorman, Miss Emma Stowe, Miss R. Inde 
Albaugh, and other members of the state society. A 
full board of nurse examiners was secured, but the 
state society does not nominate. The members are 
appointed by the governor. The requirements were : 
age over twenty-one, a diploma from a training school 
giving a two years' course and connected with a 
public or private hospital where medical, surgical, 
and obstetrical cases were cared for; or such pre- 
paration as the board should consider equivalent to 
this. The law specified seven subjects in which 
examinations were to be passed. 

In 1906 several states presented bills, but none 
was carried. 1907 had a better record. 

District of Columbia.- -The nurses formed a society 
in 1903 and had an exciting legislative contest. 
Before organisation was complete, a meeting was 
held at which the health officer of the district read 
to them a bill of his own preparation, which was 
later introduced into Congress by the district Com- 
missioners. But the nurses, then on the alert, 
realised that it did not satisfy them, and entered 
so actively into opposition that they succeeded 
in killing it. In 1905, they prepared another and 
presented it themselves. The Commissioners and 
health officer, eager to retaliate, attacked it, and the 
nurses finally withdrew their bill as being unsatis- 
factory. The Commissioners, in 1906, brought in 
a third bill which the nurses again killed in the 
House of Representatives. Following up this ad- 
vantage, they wrote their own bill, rejecting all 
other advice, looked up their own man to present it, 



The United States 163 

asked for and obtained hearings, which they man- 
aged entirely themselves, brought in petitions from 
other state societies of nurses, and by skilful manage- 
ment and personal visits, letters, and appeals, got 
their bill successfully through Congress in about two 
weeks' time, and it was signed by President Roosevelt 
on February 9, 1907. The Commissioners, though 
not endorsing, offered no further opposition. The 
society naturally felt this to be quite a triumph, the 
more so as it was all done with an expenditure of no 
more than ten dollars or so for typewriting. Those 
especially responsible for this achievement were Miss 
Paxton, Miss Greenlees, and Miss Lily Kanely, the 
president of the district association. Miss Nevins, 
superintendent of Garfield hospital, was a strong 
ally. The nurses obtained their own examining 
board, nominated by the society and appointed by 
the Commissioners. The requirements call for an 
age over twenty- three, and a diploma from a train- 
ing school which shall have been registered by the 
board, provided that none should be so registered 
unless giving at least two years in a general hospital, 
all of which is to be determined by the board. 

West Virginia formed a state society in 1905 and a 
bill was presented that same year under the leader- 
ship of Harriet Camp Lounsbery, who, before her mar- 
riage was the head of the Brooklyn training school 
and lavished her energies on public service. The 
bill contained the usual demand for a board of nurse 
examiners. Defeated as a general proposition on 
its first appearance, it was again introduced at the 
session of the legislature in 1907, passed it, and went 
to the governor for his signature. Only when the 



1 64 A History of Nursing 

nurses were surprised by a veto from the Executive, 
on the ground that the bill was unconstitutional, 
did any one realise that the constitution of West 
Virginia forbade a woman to hold public office. The 
board of nurses was, therefore, impossible. As none 
of the men concerned knew this, it is not surprising 
that the nurses did not. Mrs. Lounsbery wrote: 

I took it while in preparation, to the governor's own 
legal clerk, who did not see the error, and as there was 
not one senator or representative who knew that a board of 
women was unconstitutional, it was passed and went to 
the governor. After his veto we hastily altered the text, 
providing for a board of physicians, and it was repassed 
at 1 130 A.M., on the last night of the session. 

Several senators, when asked afterwards if they 
had ever read the constitution of the state, laughed 
and said "No." The nurses of West Virginia have, 
therefore, a full board of medical examiners ap- 
pointed by the governor. The qualifications are as 
follows: age twenty-one years; a high-school educa- 
tion ; a two years' training in a general hospital, the 
residence in hospital to be continuous and instruc- 
tion systematic. This peculiar wording shows the 
intention of guarding the pupil's education against 
commercial private duty outside. Among the most 
able campaigners was a Virginia nurse then living in 
West Virginia, Miss Naomi Simmons. 

In 1 909, an attempt was made to weaken the private 
duty clause by amendment, without the nurses' 
knowledge. It cannot be regarded as inspiring con- 
fidence in medical boards that this injurious amend- 
ment was introduced by two of the examining 



The United States 165 

physicians, one of whom directed a private sanitarium 
and the other a hospital for the insane. The secre- 
tary of the board, Dr. Lounsbery, was, however, 
loyal; the nurses, led by Mrs. Lounsbery, were vigi- 
lant, and the aggression was discovered and decisively 
repelled by energetic protest from the state society. 
Subsequent efforts at constructive improvement have 
shown the difference between a nurses' and a medical 
board. A prominent West Virginia woman said in 
1911: 

As yet we have not been able to bring our board to 
consider the subject of a uniform curriculum for train- 
ing schools. We are unfortunate in not being able to 
have nurses on the board. They are excluded because 
they are not voters, and we have been unable to inspire 
our board with enough interest in nursing matters to go 
forward. 

New Hampshire formed a state society in 1906 
and a registration act was presented and passed in 
1907. No opposition nor injurious amendment was 
offered, and no unusual incident occurred. The 
board, with one exception, is composed of nurses 
nominated by the society and appointed by the 
Regent of the State Boards of Medical Examiners. 
The Regent himself has the final place on the board. 
Applicants must be twenty years old, with diplomas 
from training schools of at least a two years' course, 
and in other respects approved by the Regent as 
maintaining proper standards. Miss B. M. Trues- 
dell, superintendent of the Portsmouth hospital, 
bore the chief responsibility of the successful 
campaign. 



i66 A History of Nursing 

Minnesota.- -The state society was formed in 1905 
and the bill presented and passed in 1907. No in- 
jurious amendments were offered, and no serious 
opposition was shown. Some objection was offered 
by the state hospitals for the insane, whose nurses 
would not be eligible without further training, but 
these protests were made in a reasonable spirit and 
the project of affiliation was accepted as meeting 
the difficulty. The examining board consists of 
four nurses and one physician, all appointed by the 
governor. A woman physician was chosen for the 
first board. The state society does not nominate. 
The requirements were twenty-one years of age, 
education admitting to high school, and a three years' 
systematic course in a general hospital, or in those 
suitably affiliated for the purpose. 

Iowa.- -The state society was formed in 1904 and 
a bill presented in 1905. It was at first defeated on 
general grounds of opposition to the demand for a 
board of nurses. In 1907 another attempt was made, 
but the nurses found that Iowa was hostile to new 
executive boards. Not only were they told that they 
could not have it, but that they could not be permitted 
to withdraw their bill ; they must either modify their 
own demand, or a bill would be passed giving the 
entire control to a board of medical examiners al- 
ready in existence. Confronted with this alternative, 
the state society accepted the inevitable, and with 
a board consisting of two nurses selected by the 
State Board of Health, two physicians belonging to 
the same board, and its secretary, the bill was success- 
fully passed in the session when presented. Though 
disappointed in the composition of the board, the 



The United States 167 

Iowa nurses feel that they have an excellent bill. 
Beginning with a two-year requirement of training, 
in a general hospital giving a good study course and 
recognised by the board, with an age of twenty- three 
years for the applicant for examination, the provision 
was made that after 1910 no school should be re- 
cognised except those attached to general hospitals 
giving at least three years of training. In 1908, 
the bill was amended to make registration compulsory 
for practice as a graduate or registered nurse. The 
nurses also aim at obtaining a training school in- 
spector. Miss Estelle Campbell, Miss Alice Isaac- 
son, Miss Luella Bristol, Miss Anna C. Goodale, and 
Dr. Louis A. Thomas were the most prominent 
workers for legislation. 

Illinois formed a state society in 1901 and its bill 
was presented in 1903, 1905, and again in 1907, when 
it was finally successful. Illinois, one of the most 
important states in the Union by reason of its giant 
city Chicago and its numerous hospitals and training 
schools, its medical schools, and its ubiquitous poli- 
tics, had one of the most lively and protracted con- 
tests in securing a registration act. It is a state 
where medical quackery in the form of diploma mills 
was once most difficult to uproot, and perhaps because 
of this family history a commercial nursing school of 
imposing theoretical dimensions, called a college, was 
able to enroll upon its faculty list the names and 
titles of numerous physicians. Having no hospital 
teaching, this foundation quite naturally desired 
to have the words 'work in hospital' 1 ' stricken out 
of the nurses' bill. Moreover, the small schools, 
of which there are a number throughout the state, 



1 68 A History of Nursing 

taking the ground that the large schools were trying 
to "put them out of business," also naturally held 
it proper to defeat, if possible, the nurses' bill. 
Having no substantial ground for opposition, as 
examination was not compulsory, they looked about 
them for support and gained that of the German 
Lutheran Synod of Missouri. The novel and in- 
genious argument was then advanced that, by having 
state supervision of training schools, there was re- 
sultant a union of State and Church, which, under 
the federal constitution, is forever forbidden. Their 
proposition was that the simple diploma of a (any) 
training school should suffice for registration. It 
is surprising that none of this opposition, determined 
and even bitter though it was, was able to defeat 
the nurses' bill in the legislature. Twice it was 
passed amidst rejoicings, and was sent to the gover- 
nor for his signature, and twice the governor's veto 
fell upon it. What the remote force was that moved 
him will never be a matter of more than widespread 
surmise. At last, in 1907, after its third successful 
passage through the legislature, Governor Deneen 
signed the bill, and it still stands. In 1909, an amend- 
ment to increase the examining board to seven was 
offered by a physician operating a small country 
hospital, but was defeated. 

Numerous and valiant was the regiment of ener- 
getic, big-hearted, breezy, and steady-headed women 
of the Middle West who won this victory. Chief 
among them were the presidents of two years, 
Mrs. Anne Hutchinson and Miss McMillan, the 
latter the head of the Presbyterian training school, 
and Miss Adda Eldrege, who stumped the state 



The United States 169 

to explain publicly the meaning and need of regis- 
tration; Miss Caroline D. Seidensticker, chairman of 
the legislative committee during all four sessions 
of 1903, 1905, 1907, and 1909; Mrs. Frederick 
Tice, who served on all the legislative committees, 
and, next to the chairman, attended more lobbies 
than any one else; Miss Minnie Ahrens, super- 
intendent of the Provident, and Sister Ignatius, 
of Mercy hospital, who gave untiring services. 
The Sisters of Mercy were from the first in the van 
of progressive action to attain legal recognition, as 
their articles in the nursing journals show. Men 
to whom especial gratitude is due are Dr. George 
W. Webster, president of the State Board of Health ; 
Dr. George F. Kreider, editor of the Illinois 
Medical Journal; Dr. Jacob Frank, who brought 
the nurses direct tidings of the enemy's doings in 
1905, Francis Donoghue, Robert McMurdy, and 
Senator A. C. Clarke. Too many to mention here 
were those nurses, physicians, and laymen who gave 
work and influence, but they will be found recorded 
in the nursing journals. 

The board of nurses is chosen by the governor 
but is not appointed by the state society. Ap- 
plicants must be twenty- three years old, and, 
after July i, 1910, must have had a three years' 
systematic course in a general hospital, or in 
affiliated special and general hospitals. (This 
arrangement met the wishes of the managers of the 
state hospitals for the insane.) The board may 
make further rules for qualifications to be demanded. 

Georgia.- -The nurses of this state formed their 
society in 1907, presented a bill to the legislature 



170 A History of Nursing 

three months after organising, and passed it in the 
same year, an example of rapid action unequalled 
elsewhere. Georgia nurses met a sad lack of chivalry 
from medical men. None helped them and the state 
medical society appointed a committee to amend the 
bill. During the campaign a circular letter was sent 
to all the physicians of the state, urging them to 
oppose or defeat it, as 

It will work a great deal of inconvenience to the 
medical profession, and to the general public, by cutting 
off the supply of available nurses; by putting them in a 
position where they can be very independent and refuse 
work when they wish to, and by increasing prices. It 
will also interfere with the training of young women from 
good families in the state, that have been unfortunate 
in their education thus shutting off the supply of 
pupil nurses to sanitariums. The latter will, therefore, 
be forced to employ expensive nurses, thus increasing 
the outlay of each of them to several thousand dollars 
a year. 

Georgia was also assailed from abroad. In that year 
the enemy in Pennsylvania was active, and a Phila- 
delphia physician made a pilgrimage to all states 
where legislation was pending, distributing widely 
a pamphlet composed of misunderstandings. He 
was met and refuted by Mrs. A. C. Hartridge, 
a woman of ability, character, and social position. 
A good bill was secured with an examining board of 
nurses nominated by the state society and appointed 
by the governor. Applicants must be twenty-one 
years of age and graduates of regularly chartered 
training schools connected with general hospitals 
or sanitaria with medical, surgical, gynecological, 



The United States 171 

and obstetrical services, giving a three years' course 
with systematic instruction in the same institution 
or in a properly affiliated group. Mrs. Theodosia 
Wardell, chairman of the legislative committee, 
shared the chief honours with Mrs. Hartridge. Their 
personal work and influence carried the campaign. 
The necessary expenses were borne by the nurses' 
associations of Savannah and Atlanta. 

Wyoming formed a state society in 1908 and its 
bill was presented in 1909, passing in the same year. 
There was little opposition, some slight objection 
only being offered by a few untrained nurses and the 
physicians employing them, and no injurious amend- 
ments were inserted. On account of the difficulty 
of holding large meetings in the state, with its broad 
agricultural extent and few cities, the whole work 
of passing the bill devolved upon Mrs. Amy E. Miller 
and Miss Martha A. Converse. The latter wrote: 

We had little opposition and much encouragement 
in the open-minded Western spirit of the people of the 
state. Our bill was introduced in the senate by Dr. 
Price and strongly supported in the house by Dr. Ben- 
nett. The work was, however, quite laborious, as the 
area of the state made it an arduous detail to get into 
communication with nurses and doctors in the different 
sections. 

The state society nominates the members of the 
board of nurse examiners, who are appointed by the 
governor. Applicants must be twenty-one years of 
age, and possess general qualifications to be fixed by 
the board. After July, 1910, they must hold diplo- 
mas from general hospitals that had been registered 



172 A History of Nursing 

by the board as maintaining satisfactory standards, 
and giving at least two years of systematic training or 
three years in affiliated general and special hospitals. 

Oklahoma, then the youngest of states, also did 
well. The state society was formed in 1908, and 
the nurses got to work at once on a bill which was 
presented and passed in 1909. This victory was 
carried in the face of formidable opposition from 
correspondence schools, the Philadelphia pilgrim 
arriving in time to scatter leaflets and make speeches 
against registration. The society secured an exam- 
ining board of nurses nominated by the society 
and appointed by the governor. Applicants for 
registration are to be twenty-one years old, and after 
five years are to present a high-school certificate and 
diploma from a general hospital giving a two years' 
systematic course of training and instruction with 
continuous residence in the hospital. Here again, 
is the safeguard against exploitation. 

Washington formed a state society in 1903 and 
carried its bill successfully in 1909, with little or no 
opposition, but with two undesired changes. The 
examining board of nurses is appointed by the 
governor, but the right of nomination by the society 
was refused, on the ground that it would then be a 
closed corporation and out of harmony with the 
state laws. The nurses had asked for an age limit 
of twenty- three, but this was altered to twenty by 
the legislature on the frivolous ground that some old 
maids wanted to bar out the younger women. No 
waiver or time of grace for untrained nurses was 
given, but all applicants for registration must have 
had two years in a general hospital, or at least the 



The United States 173 

same kind and extent of service, all of which is left 
to the board to decide. Ten subjects for examina- 
tion are named. The Washington nurses did very 
systematic campaign work through their county 
associations. Every man in the legislature was 
personally interviewed and local influence brought to 
bear on him. The latest incident of note has been 
the appointment of a training school inspector or 
State Superintendent. One year after the nurses' 
bill was passed, Washington enfranchised its women, 
giving a [then] fifth equal-suffrage state to the Union 
and making four where nurses had both organisation 
and political equality as well. 1 

Nebraska. Here, too, the extent of territory and 
comparative sparseness of population made the 
initial work of organisation difficult for the nurses. 
A state society was formed in 1905, but not until 
1909 was it strong enough to enter the legislative 
field. When its bill was presented, it was at once 
attacked by a faction representing a six-months' com- 
mercial course of training, and so strong was this hos- 
tile force and so sympathetic the legislature toward 
the opposition that, in order to maintain their posi- 
tion and prevent another group from passing a much 
worse bill, the nurses accepted weakening amend- 
ments, trusting to time and the growth of popular 
education to upbuild it in the future. The examining 
board is of nurses, while the State Board of Health, 
of which the governor is one member, is the super- 
visory power. It appoints the nurse examiners, who 

1 Utah, the fifth, has no organisation of nurses, nor is the influence 
of her weird politico-religious hierarchy favourable to such develop- 
ment. California is now the sixth. 



174 A History of Nursing 

are called secretaries, from an eligible list prepared 
by the nurses' society. The bill does not indicate 
that the society nominates, but by the rules of the 
board it does so. The board of health prescribes 
the duties of the examiners and makes regulations 
under the act. The rules of the nurses' board require 
the examiners to inspect all training schools annually. 
Applicants must be twenty-one years of age, with an 
education sufficing for entrance to high school, and 
a training-school course of two or three years in a 
hospital, sanitarium, or sanatorium with general ser- 
vice and giving systematic instruction. Graduates 
from special hospitals giving a two years' course may 
come up for registration after taking six months' 
work in a good general hospital. Seven subjects are 
specified for examination. The legislative commit- 
tee of the state association, Miss Anna Hardwick, 
Miss H. J. Fisher, and Miss L. B. Stuff, devoted 
themselves assiduously to the cause, and merit full 
recognition for their ability in holding their ground 
under difficult circumstances. 

Texas.- -The immense extent of this state with its 
few scattered nurses gives special prestige to the 
valiant work they did in organising a society in 
1906, at Fort Worth Medical College, with twenty- 
five members. At this very first meeting the draft of 
a registration act was drawn up, and Miss Bridges, 
Miss Jennie S. Cottle (now Mrs. Beaty), Miss Van 
Doren, and Miss M. M. McKnight, representing the 
large towns, took up with energy the task of making 
known the cause and building up the association. 
Three years were spent thus, until in numbers and 
finances the society was able to carry the bill into 



The United States 175 

the legislature of 1909, where it passed successfully, 
with no injurious amendments, in the same year. 
No physicians stood forth conspicuously either in 
opposition or support, but Senators Meacham and 
the blind, beloved Stephan, with Representative 
Worthain, were the lay champions who carried the 
bill to victory. Only one senator opposed the bill 
on the ground that it excluded the "experienced" 
woman. The examining board is of nurses, appointed 
by the governor, but the right of nomination by the 
society is no.t specified. The bill forbids practice 
without registration, except to the untrained, and 
fixes no standard of training, but empowers the board 
to do so by its rules. As adopted, these rules require 
two full years in hospital as the minimum, and forbid 
undergraduate private duty except for three months 
in the last of a three years' course. The state 
society planned working as soon as possible for an 
amendment asking training schools to provide a 
systematic course and a curriculum as nearly uniform 
as possible, and to place graduate nurses, registered 
in Texas, at the head of each. 

Delaware. In March, 1909, little Delaware came 
in with an excellent bill requiring three years' training 
in a general hospital, with a high-school education 
as an essential preliminary. It has a board of five, 
three nurses appointed by the governor on the state 
society's nomination, and two physicians, repre- 
senting the two dominant medical schools. 

Pennsylvania. From the outset of organisation 
the nurses of this state met the hostility of vested 
interests. There are many special hospitals (enjoy- 
ing state appropriations) and private ones, all, with 



176 A History of Nursing 

few exceptions, conducting training schools. The 
largest directory in the state had long been controlled 
by physicians, who discouraged united action among 
nurses. An association for training pupils in short 
terms was strongly organised. On the other hand, 
Pennsylvania has a large number of excellent schools 
for nurses, thanks to the labours of women whose 
reputation as nurses and executives is honourable. 
In the winter of 1904-5, the nurses presented an act 
to the legislature. Though moderate in its scope, 
it was promptly defeated by the influence of medical 
specialists. In 1907, the nurses offered concessions, 
but still met opposition. Counter organisations 
went so far as an existence on paper. The Ameri- 
can Journal of Nursing said in July, 1908 (p. 750): 
'The Pennsylvania State Committee of Nursing is 
again working vigorously to frustrate the nurses' 
efforts to obtain registration. It plans to establish 
not only a State but a National Board of Regents 
(medical men) to control registration." But these 
efforts fell flat, for the state medical association 
had sent Dr. W. L. Estes to the nurses with a 
promise to help them. In 1908, renewed efforts 
to this end were made; the nurses travelled through 
the state giving addresses of explanation as to 
what they really wanted and what it meant to 
the public weal; and in 1909, at the end of the 
session, their bill went through and was signed. It 
gives an examining board of five, all to be appointed 
by the governor; three are physicians, of whom two 
must be connected in an official capacity with public 
hospitals having training schools for nurses, and two 
are nurses, of whom it is only required that they shall 



The United States 177 

be graduates from schools attached to general sur- 
gical and medical hospitals, without specification 
as to length of training. Applicants must be twenty- 
one years of age, and have graduated from training 
schools giving at least two years' course of instruction 
(no specification is made here of hospital service; 
and consequently schools which taught their pupils 
without giving them such service might possibly be 
recognised), or have received instruction in different 
training schools or hospitals for periods of time 
amounting in all to at least two years (such periods 
to include practical and theoretical training in 
surgical and medical nursing), and terminated by 
graduation (from some one or more of said schools or 
hospitals). 

Scanty though this victory was, it was won in the 
face of extreme odds. The American Journal of 
Nursing said in April, 1907: 

In Pennsylvania the public press has shown a kind of 
opposition more malicious and vindictive than has been 
found in any of the other states since the registration 
movement began. In the name of the medical profes- 
sion, facts and standards have been falsified and mis- 
represented to an extent which lowers one's respect 
for the honesty of the men who have taken part in the 
opposition. 

In 1910, the war was renewed at a lively rate, 
because certain applicants were deemed by the board 
of examiners to be insufficiently prepared and were 
not admitted to examination. The newspapers 
gave columns to the controversy, which was carried 
on chiefly by physicians. Those having grievances 

VOL. III. 12 



178 A History of Nursing 

declared that " nurses carried kits/' 'tried to walk 
like doctors," were "officious meddlers in the sick- 
room," read medical papers, and reversed medical 
orders. Dr. Taylor said: "If this thing keeps on I 
do not know what will happen; I see a solution in 
taking a half-trained nurse and training her in my 
own way, under my own orders." He added: "She 
should be a servant. That is her sphere, and it is 
an honourable one. If she is a servant amenable to 
orders, obliging, tactful, considerate, there is no fault 
to find with her." Dr. Beates produced a letter, 
written to the Physicians' National Board of Regents 
by Dr. Wampler, of Indiana, with this dreadful testi- 
mony : ' ' The supremacy and autocracy of the trained 
nurse in Indiana confront us." 1 Dr. Beates shud- 
dered at the "hard-visaged, iron-jawed, close-fisted, 
selfish leaders of the nurse-opathic crowd,' and 
looked for the day when R. N. should signify 
' Retired Nurse ' : -occupation gone. 

The medical members of the examining board sent 
manly, dignified, and emphatic protest to the papers, 
Dr. Higbee, the president, being especially explicit. 
Part of his reply ran as follows : 

It is the policy of the board to take the broadest view 
of the wording of the law and to register the graduates 
of all the training schools of the state which are con- 
nected with hospitals. It is the opinion of the board 
that a pupil can acquire a knowledge of nursing only 
by actually handling and waiting upon the sick and be- 
coming practically acquainted with the appliances neces- 
sary for their treatment and comfort. 

1 See the Philadelphia Ledger and other daily papers for April 23, 
1910, and thereabouts. 



The United States 179 

He then went on to state that applicants from a cer- 
tain institution having presented themselves "it is 
the judgment of the board that the school does not 
give a course which fits a person for the responsibilities 
of a nurse. . . . The board is convinced that the 
prime object of the school is entirely of a mercenary 
character." 1 Dr. Higbee then continued with the 
plainest possible statement of facts, as to the organ- 
isation and methods of the corporation in question, 
so that, during this newspaper war at least, the whole 
question of training was thoroughly thrashed out 
for the benefit of the public in general. Perhaps the 
most extraordinary thing said in this connection was 
a statement of Dr. Dulles in a printed pamphlet 
culled from the Public Ledger of October 16, 1908, 
as follows: "The training schools for the education 
of women are splendid things, but after all it must be 
remembered that their purposes are only educational. 
Elaborate training in the art of nursing is not essen- 
tial to the patient. It is only gratifying to the nurses 
themselves. 2 

Missouri. The state society was formed in 1906 
and a registration act was presented in 1907. No 
opposition was met nor amendments offered, but the 
bill did not reach its third reading before the adjourn- 
ment of the legislature. In 1909, it went through, 
practically without opposition, except for some little 
from the country districts. There is an examin- 
ing board of nurses appointed by the governor, but 

1 In 1911, a nurse from this institution presented herself for regis- 
tration, and was refused. She brought suit against the board, but 
the courts ruled against her and upheld the examining board. 

3 Italics are ours. 



i8o A History of Nursing 

not nominated by the society. Applicants must 
be twenty-one, with a grammar-school education. 
After 1912, the diploma must be from a training 
school connected with a general hospital, sanatorium, 
or special hospital having a two or more years' course 
and giving systematic instruction, or from one or 
more affiliated hospitals giving an equivalent course. 
Dr. Herman Pearce and Dr. James Stewart, with 
Miss Charlotte B. Forrester, Miss Eleanor Keely, 
Mrs. Gertrude Gibson, and Mrs. Mabel Long- 
Freytag were the leaders in the movement. Their 
section of the country is one of great promise, and 
gives a fine type of woman to the nursing profession. 

Michigan's society was formed in 1904, and a 
bill presented in 1905, but twice defeated before 
passing in 1909. Medical opposition was here also 
the obstacle. It seemed to centre in Detroit, whence 
came a committee of physicians to argue against 
the bill. While it was in for the second time, a sub- 
stitute was unexpectedly introduced by Dr. L. L. 
Keely providing for control by the state medical 
board. The nurses wrote: 'Had we believed the 
newspaper articles at this time, we would have given 
up the fight as hopeless. We did not do so. It was 
shown that, in spite of the fact that the state medical 
association, through its legislative committee, op- 
posed the nurses' claims, the majority of individual 
physicians were our friends, and many were working 
for us." The nurses' committee districted the state, 
appointing local chairmen to interview personally 
every senator and assemblyman; petitions were 
circulated among physicians, nurses, and the general 
public, and resolutions obtained from county medical 



The United States 181 

societies, women's clubs, etc. Nevertheless, before 
the bill could be passed, the nurses were compelled 
to make two substantial concessions: one as to 
their board, and one as to the length of training, 
which they had wished to fix at three years. They 
yielded to the two-year minimum, and then agreed 
to a mixed board. As finally amended it consists 
of three nurses, one registered physician, and the 
secretary of the State Board of Health. The 
governor appoints the examiners with the advice 
of the senate. Applicants for examination need 
not be of a minimum age, and shall show diplomas 
from training schools, connected with hospitals 
giving a two years' course of training with sys- 
tematic instruction in a general hospital, state 
hospital, sanitarium, or special hospital in good 
standing. The rules for the examination as pre- 
scribed by the board shall be sent from time to 
time to any institution applying therefor. Mr. F. 
C. Schneider and Representative N. C. Rice were 
pre-eminently the two friends to whom the nurses' 
gratitude for loyal service was due, and among the 
specially active workers were Miss Agnes Deans 
and Miss Mary Haarer, Miss Elizabeth Parker and 
Miss Elizabeth Flaws. 

After the passage of the act, an incident of an 
unusual kind occurred. Certain requirements as 
to training and experience were fixed by the 
statute for the three nurse examiners. To the sur- 
prise and chagrin of the association the governor 
made an appointment which disregarded these re- 
quirements. One of his appointees had not had 
the necessary years of practice. It seemed oddly 



1 82 A History of Nursing 

like a political appointment, for remonstrances 
had no effect. The nurses had, therefore, no alter- 
native but to carry on a legal contest with the 
governor of the state. They did so, without hesita- 
tion, and won it too, at a cost of three hundred 
dollars, which seems, after all, a modest sum ior de- 
feating a governor. 

Massachusetts. The state society was formed in 
1903. From its inception and even earlier those 
undertaking the task before them knew it would be 
a knotty one, because of the structure of the Waltham 
school and the firm determination of its head, Dr. 
Alfred Worcester, not to alter it. The core of its 
system was the training of pupils wholly in private 
duty under the oversight of the physicians in attend- 
ance. In recent years some hospital service has been 
added, and a most excellent preliminary course in 
all the practical domestic arts which would make it 
a desirable member of an affiliated group. The per- 
sistency with which Dr. Worcester retained the dis- 
credited feature of private duty, however, prevented 
the recognition of the school in other states 
where registration had been attained, and brought 
about a long and obstinate contest. One year after 
the state society was formed, he led in organising 
the 'New England Association for the Education 
of the Nurse," to which hospital directors and su- 
perintendents, .training-school superintendents, and 
nurses in the ranks were bidden. The example to 
which he pointed in advocating this mixed society 
was the similar one in Holland, which, as we shall 
see, has really stifled free speech and retarded the 
nurse's education. 



The United States 183 

The Massachusetts nurses introduced their bill 
in 1904, and again in 1905. Each time the opposi- 
tion was so overpowering that they withdrew rather 
than submit to amendments. Defeat was brought 
about in 1905 by men representing the New England 
Association, though Dr. Worcester himself did not 
appear. Again in 1906 an attempt was made with 
the same result. In 1907, a fresh effort was made. 
This time the bill was reported favourably to the 
lower house and passed, only to be unexpectedly 
defeated in the senate by the defection of a supposed 
friend. In 1909, having gathered fresh forces and 
renewed energy, the nurses came forward again. 
At this time the American Journal of Nursing said: 
" No group of nurses, in their efforts for registration, 
have had to meet such bitter opposition from phys- 
icians of high standing." The opposition was, 
indeed, formidable not abusive and vulgar, as in 
Pennsylvania, but astute and skilful. At last, at 
one of the hearings in 1909, a substitute bill based on 
the Waltham method of training having been offered 
by Dr. C. H. Cook, Dr. Worcester appeared in person 
to complain that Waltham nurses were excluded 
from examination in other states and to claim re- 
cognition for them in Massachusetts. Ex-Governor 
Bates, who was in charge of the nurses' bill, asked 
if he did not think the wisdom of sixteen other states 
worth more than his own? But the bill failed again. 
In 1910, always under the leadership of Miss M. M. 
Riddle, who, as president of the society, had borne 
the brunt of work and responsibility from the outset, 
and whose patience and fortitude had never wavered, 
the Massachusetts nurses' bill finally passed safely 



,184 A History of Nursing 

through both houses of the legislature, and was 
signed by the governor on April 29th. It is by no 
means the bill that they would have had it, but gives 
a vantage-point to work from. The careful moder- 
ation of its text would seem to leave the dispute with 
Waltham still unsettled, had not the experience of 
other states shown that in the powers of the exam- 
ining boards there is sometimes a reach not indicated 
in the bare wording of the text. The governor 
appoints a board of five, three of whom shall be nurses 
holding diplomas from different training schools for 
nurses, giving at least a two years' course in the theory 
and practice of nursing in a hospital, and who shall 
have had eight years' experience in nursing the sick ; 
one member shall be a physician who is a superin- 
tendent of a hospital having a training school for 
nurses, and the fifth member shall be the secretary of 
the State Board of Registration in Medicine. Ap- 
plicants for examination are simply to prove that 
they are at least twenty-one years old, and of good 
moral character. Then if, upon examination, the 
applicant shall be found qualified, she shall be regis- 
tered. Examinations are to be in part written, and 
in part practical demonstration, and shall include 
the principles and methods of nursing. 

In 1911, at the end of the legislative session and 
after the foregoing pages had been written, five 
more States gained registration victories: Idaho, 
Oregon, Vermont, Tennessee, Wisconsin. The first 
secured an excellent bill. An interesting point is 
that the president of the board is also made the in- 
spector of schools, and it is also noteworthy that, 
the examining board being composed of two nurses 



The United States 185 

and one physician, the nurses' society submits the 
names of both nursing and medical nominees to the 
governor. 

The Oregon law is one of the best yet gained, with 
a board of nurse examiners nominated by the state 
society, the president of the board made training- 
school inspector, and a good standard. It met 
practically no opposition, and was carried through 
by Miss Linna C. Richardson. 

The history of the Vermont act is unique, as it was 
not worked for by nurses at first but was projected 
and carried through by the efforts of Dr. Charles S. 
Gale, of Rutland, from disinterested motives, and 
passed easily, meeting very little opposition. Dr. 
Gale had had his interest excited by learning that a 
Vermont nurse had been refused membership in a 
central directory of New York State because she 
was not eligible for the state examination, her school 
not having been registered by the Regents. He then 
set to work to remove this disability from the nurses 
of his state, and carried the act through, aided 
effectively by the chairman of the House Committee 
on Public Health, Dr. W. N. Bryant. The bill has a 
moderate educational standard and gives an ex- 
amining board of two physicians and one nurse. 

The Tennessee bill had a hard fight, led ably by 
Miss Lena A. Warner, president of the state society. 
Though concessions had to be made, it came through 
well. Its examining board of five nurses must have 
the endorsement of ' the society of nurses to which 
they belong." The bill is mandatory. Wisconsin 
gained a bill excellent in many respects, with a board 
of five nurses appointed by the State Board of Health. 



i86 A History of Nursing 

After a three years' period of grace applicants shall be 
admitted to examination if over twenty-one, and 
graduated from schools giving an adequate and 
systematic course of training of three years. This 
course may have been taken either in a good general 
hospital, not more than three months of the senior 
year having been given to outside nursing, or in a 
special one during two years, with a third spent in a 
good general hospital. To the usual list of subjects 
for study there is added Nursing Ethics. r 

In giving this summary of the registration cam- 
paign, it has not seemed needful to repeat details 
which can be found in the given sources of reference, 
but simply to indicate its character as a part of the 
educational movement of our day, and as a feature 
of the advance of women toward legal equality. If it 
be asked, 'What has registration done?' it may be 
definitely said that even in this short time it has 
proved to be a potent stimulus to hospitals to im- 
prove their methods of training by laying aside their 
individualistic attitude and conferring together. A 
truly remarkable process of affiliation between in- 
stitutions began almost immediately after the passage 
of the first act. The most prominent example of 
this may be found in the report of the Belle vue school 
for 191 1, showing that twenty-three hospitals in other 
places, including New York State, Massachusetts, 
New Hampshire, Long Island, Vermont, District of 
Columbia, and Rhode Island, were sending their 
pupils to Bellevue for affiliated training, the number 
of these pupils running into the fifties, and that post- 

1 The full text of all bills can be found in the files of the A.~J. N, 
See also State Registration for Nurses, by Louie Croft Boyd, 1911. 



The United States 187 

graduate pupils from all over the Union numbered as 
many more. It has been found that many schools 
are glad to have a standard given them, while others 
could never have been reached except by state 
officers. 

Practical arts have been quickened by state exam- 
inations, for nurses' boards lay especial emphasis on 
dietetics, the personal comfort and skilled handling 
of the patient, and general management. But there 
are sheer mountains to be moved, for, with pupil 
nurses now numbering thousands, the problem of 
training nurses has become the problem of the home 
training and early education of the average girl. 

The Religious Nursing Orders. --The history of 
the religious nursing orders in the United States is 
one of ready adaptation to modern medical and social 
conditions. Soon after the training-school move- 
ment was launched, the Sisters of the various hospital 
orders began providing instruction for their own 
novices, and next opened schools for the training 
of secular nurses. In this new field the first were 
the Sisters of Mercy in Chicago and the Sisters 
of St. Mary's in Brooklyn. Their schools were 
opened in 1889. Next came St. Vincent's in New 
York, under the Sisters of that order, and with which 
Miss Sanborn, a New York hospital graduate of 
winning and dignified presence is closely identified, 
and that of the Carney in South Boston. Both 
were opened in 1892. At the present day it is prob- 
able that every active hospital order in the country 
has a more or less well developed training school for 
nurses, and that each provides also some degree of 



1 88 A History of Nursing 

training for the Sisters who are to engage in nursing ? 
even though this may not always be as thorough as 
the preparation of the secular nurse. The Sisters 
of Mercy, however, are fully trained, taking their 
hospital course before the completion of their vows ; 
therefore, like the members of Anglican orders, these 
Sisters take the personal direction of all branches 
of hospital work, and act as head nurses, operating- 
room Sister, and superintendent of training school. 
The standing of the Sisters' schools keeps pace with 
the others of the communities where they are found. 
The graduate nurses from the Sisters' schools 
have their alumnae associations, join larger groups, 
and take part in every professional movement. The 
superintendents are active in their state and national 
societies, and the Sisters themselves come forth effect- 
ively in educational campaigns. The whole regis- 
tration work owes much to their help. Indeed, there 
have been no exceptions to the uniform support 
they have given it. In certain ones of the most 
actively contested struggles, as Illinois and New 
York, their alliance has been of a definite and em- 
phatic character, which helped greatly to save the 
day. The Sisters of Mercy wrote timely articles 
advocating registration. The Sisters of St. Vincent 
subdued uncouth legislators. In Maryland, where 
the orders are strong and have numerous hospitals, 
their co-operation in the high standard set by the 
act was general. Miss Ross was admitted to the 
Sisters' schools in her tours of inspection, and 
the nuns conferred freely with the members of the 
examining board. 

It is a stirring sequence that brings the Sisters of 



The United States 189 

Mercy into close comradeship with American nurses, 
for theirs is the order, described in the Irish chapter, 
that sent a staff with Miss Nightingale to the Crimea. 
Sister Mary Ignatius, the Superior of the Mercy 
Hospital in Chicago, Sister Mary Veronica, superin- 
tendent of nurses and principal of the training school, 
and Sister Mary Rita, the assistant superintendent, 
are well-known names among Western nurses. Some 
of the teachers and supervisors in the school are 
secular. The order was founded in this country 
in 1843. The initiative and energy of the Sisters 
are suggested in the lines that follow: 

From the beginning, the Sisters in charge of Mercy 
Hospital have always commanded the very best medical 
and surgical staff in the Northwest. Whenever new and 
good methods sprung up they were at once adopted. 
And so, in the course of time, when bacteriology had 
proved that germs were the source of disease and in- 
fection, and when science had pointed out that scrupulous 
cleanliness, disinfection, and sterilisation were the best 
means to use in counteracting their pernicious activity, 
woman's work became indispensable. With the growth 
of Chicago, the hospital had also expanded, and it 
was soon found that the Sisters alone could not attend 
to the daily growing number of patients. It was the 
need for more women trained in hospital work that caused 
the training school for nurses to spring into existence. 

The Sisters of Mercy were among the first to recognise 
the needs of the times and forthwith set about instructing 
the members of the Sisterhood and young women who 
manifested a desire to engage in that field of labour. 
Drs. Andrews, Jaggard, Hall, Davis, and others gave 
lectures to the Sisters and young women who formed 
the nucleus of the present training school. Several of 



190 A History of Nursing 

these first pupil nurses have followed the call of the 
Good Shepherd and entered the Sisterhood to continue 
the good work then begun. 

In 1 889 the school for nurses was regularly organised 
and a charter was secured from the State in 1892. A 
change was made in 1901 from the old two years' course 
with one month's to a three years' course with two 
months' probation. In 1905 the school affiliated with 
Northwestern University. Since then the nurses gradu- 
ate with the students of the university. Affiliation 
with the university gives to the student nurses the 
advantages of the laboratories of the medical school of 
that institution and they receive their theoretical course 
under the direction of the faculty. 1 

An Anglican order that here rose to prominence in 
nursing is that of St. Margaret's, 2 whose work in 
this country began in the following way: About 1869 
several physicians of Boston, desiring to found a 
hospital for children, and having visited the one in 
Washington recently developed from the work of St. 
John's Sisterhood, secured the interest and practical 
aid of Mrs. Tyler, a deaconess well known in New 
York and Baltimore, who, as a friend of Dr. Francis 
H. Brown, offered her services for the undertaking. 
After beginning in a small way with a few associates, 
Mrs. Tyler proposed applying for help from one of 
the English Sisterhoods, and eventually the Superior 
of St. Margaret's, East Grinstead, sent Sister Theresa, 
who had been thoroughly trained at the Westminster 
and the Children's Hospital in Great Ormond Street, 
to look over the new field. Upon her arrival she was 



1 Report for 

a See Vol. II. for early history. 



The United States 191 

given full charge of the nursing, much of which was 
done under her own hands, and was finally elected su- 
perintendent. In 1873, two more Sisters came from 
England, and the Community of St. Margaret's in 
Boston then came into being, with Mother Mary 
Louisa as its venerated Superior. The first private 
hospital in Boston was the St. Margaret's Infirmary, 
which was begun informaly in 1881 with a single 
patient who was taken at her own urgent request. 
This grew to a large service, and was nursed entirely 
by the Sisters until its discontinuance five years ago. 
In 1883, the hospital for children was moved to its 
present extensive quarters, a convalescent home 
opened in connection with it, and a new era of 
growth and efficiency began. 

The training school for nurses is established on 
a solid educational basis, providing a scientific and 
practical course of instruction for three or more 
years, and is recognised throughout the country as 
one of the select group whose methods and standards 
are unquestioned. A high-school diploma is re- 
quired of each applicant, with the added require- 
ment of four months of academic work at Simmons 
College successfully completed before they are 
formally enrolled pupils. The course includes a 
compulsory four months of adult nursing at the 
Massachusetts General, with three months of 
private nursing under instruction at Corey Hill 
and six months at the Lying-in as elective courses. 
The academic work ranges from the preparatory 
instruction in anatomy, chemistry, and materia 
medica, through advanced lectures and clinics on 
special subjects, and the practical work keeps pace 



192 A History of Nursing 

through every department of expert nursing and 
executive work. 

The Sisters have active branches in Newark, N. J., 
Montreal, and Philadelphia. One who knows them 
well writes: 

If it may have seemed to any that, in the development 
of nursing, the Sisters of Mercy belonged only in their 
mediaeval environment and had no place in the modern 
scientific world, to them a brief survey of the work done 
by the Sisters of St. Margaret in the very forefront of 
pioneer reform, and maintained to-day at the highest 
mark of efficiency, may well be a notable enlightenment. 
If we go farther, and seek the inner psychological signifi- 
cance as well as the outward material accomplishment, 
it is not indefensible to suggest that science and religion 
each find their complement in the other, and only when so 
joined together do they realise their completest fulfilment. 
Souls must be cared for as well as bodies, and the ab- 
solute consecration and devotion of the religious life must 
leave its stamp upon the work of nursing an influence 
of silent power greatly needed, and too often greatly 
missed, in the relentless tide of modern hospital life. 

Besides its admittedly model character as a train- 
ing school, the Children's of Boston exerts a salutary 
influence in general nursing affairs. The Sisters are 
public-spirited, and Sister Amy, the superintendent 
of nurses in 1911, is a leader in educational matters. 
It may seem strange, but is none the less true, that 
the Sisters are more free to define and maintain 
educational standards than are some other training- 
school heads in Boston hospitals, whose positions are 
too far subjected to the hospital superintendents. 

American-Indian Nurses. Could the Canadian 



The United States 193 

Sisters of Charity, who first taught Indian women 
the rudiments of nursing two hundred years ago, 
look now upon the skilled nurses in uniform belonging 
to the Indian race, they might well feel a mixture 
of pleasing sensations. Against the many crimes 
toward, and colossal misunderstandings of, the red 
man on the part of the conquering white race, may 
be offered as partial atonement the work of Indian 
schools, especially Carlisle, in educating the Indian 
youth. Carlisle has a list of some twenty or more 
Indian girls, who, after completing their general 
education at the United States Indian School, have 
entered hospitals for training. They all have good, 
and some exceptional, records. Among them are 
Charlotte Harris, a Cherokee; Estaiene Depeltque- 
stangue, a Kickapoo; Seichu Atsye, a Pueblo, and 
others from whom personal notes of professional 
work have been obtained. An Oneida, named Nancy 
Cornelius, now r dead, was the first Carlisle pupil who 
received a nurse's diploma. "She was the pioneer 
Indian nurse " (writes Mr. Friedman, the superintend- 
ent) : 'and was most excellent in her profession." 
The Indian woman has qualities that fit her excel- 
lently for the nurse's calling. Her nerves are under 
perfect control, and she is quiet and gentle. In 
cases that demand calmness and quick action she 
never fails, nor is she ever terrified by the sights and 
sounds of hospital life. 

While Carlisle sends its pupils to well-known large 
hospitals for training, it has also developed a hospital 
and training school of its own, which, as lately re- 
organised, aims at taking first rank in careful, thor- 
ough work, though the nurses will continue to be 

VOL. Ill 13 



194 A History of Nursing 

trained in affiliation with city hospitals. The 
Journal of the Carlisle school says: 

A thorough course in nursing is being formulated 
which will comprehend recitation work, lectures, de- 
monstrations, and actual practice. Arrangements are 
being completed with the best hospital training schools 
in Philadelphia, such as the German, that of the Univer- 
sity of Pennsylvania, and the hospitals of other eastern 
cities, whereby our nurses will be admitted to advanced 
standing in these schools, after completion of our course. 

Indians make splendid nurses. By nature they are 
adapted to this work. The are deft with their fingers, 
patient and sympathetic with those who are ill. With 
our well-equipped hospital, a limited number of carefully 
selected young women will find ideal opportunities for 
studving this noble profession. Carlisle is fortunate in 
being situated near Philadephia, the greatest medical 
centre in the United States. A number of Carlisle 
graduates are already successfully following this pro- 
fession in all parts of the country, and from the auspicious 
beginning which has now been made the number will 
be continually increased. T 

Miss Juliette Two-Axe, an Oneida, writes from 
Chicago: "I wish more Indian girls would take the 
course in nursing. I find it fascinating, uplifting, 
and beneficial." Mrs. Zippa Skenandore is a married 
nurse, and finds her training useful in family life. 
She writes from Wisconsin: 

I think nursing is the grandest thing for girls to know, 
how to take care of the sick in their own family or in 
others. I know I never regretted that I did learn nurs- 

1 The Red Man, a monthly magazine by Indians, October, 1910, 
p. 87. Carlisle Indian Press. 




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The United States 195 

ing, though I did not take it up after my graduation at 
the Connecticut training school, except one year. Then 
household duties came on and I have a family of 
seven to take care of. It is a great help to me. 

Mrs. Betty Wind Driven, a Methodist Episcopal 
graduate, says: 'I like nursing in all its branches, 
and my opinion of it for the Indian girls is that they 
are gifted with the art of nursing." 

A number of the Carlisle nurses have married, and 
some of the best have died, while others, scattered 
over the country, are busy, successful, and happy in 
their work. 

American-Negro Nurses. In the rapid progress of 
Negro women in nursing may be seen another strik- 
ing example of the efforts made and achievements 
accomplished against fearful odds by a people first 
subjected to the most cruel oppression and then 
turned loose, as it were, to fend for themselves. Ne- 
gro applicants to training schools found the way 
barred to them in most hospitals, though in some 
states an occasional Negro probationer was taken 
into good schools, the pioneer coloured nurse, Miss 
M. E. P. Mahoney having graduated in 1879 from 
the New England Hospital for Women and Chil- 
dren. To meet the need of training, therefore, the 
first school was opened in 1891 in the Provident 
of Chicago, an institution which was founded and 
partly endowed, and is entirely controlled by coloured 
people. In the announcement of its incorporation, 
it is stated that "a number of men imbued with a 
desire to be useful to others decided to organise a 
hospital and training school for nurses." The school 



196 A History of Nursing 

was to be the feature of the institution, and it has, 
indeed, worthily attained its purpose. The first 
superintendent of nurses was Miss Weaver of the 
Illinois training school, and within twenty years 
after its foundation the hospital had sent forth more 
than a hundred well-taught nurses. They come 
there from every part of the Union and Canada, 
and many have taken charge of other training 
schools which have grown up with rapidity in many 
cities. Philadelphia has the Mercy and the Frederick 
Douglas Memorial hospitals; Washington, D. C., 
has the Freedman's; New York City, the Lincoln; 
Tuskegee and Hampton have their hospital nursing 
schools, and hospitals in Montgomery, Alabama 
(Hale Infirmary), New Orleans (Straight University), 
Taladega (the same name), Savannah (Georgia 
Sanitarium), Augusta (Lamar Hospital and Bur- 
ner Sanitarium) , Macon (Lincoln Memorial) , Atlanta 
(Atlanta School of Medicine) , with others for which 
space fails, are striving to meet the problems of 
medical care, and medical and nursing education. 

Like other Southern races, the Negro nurses have 
been chiefly led at first by those of a more experienced 
race. White superintendents have done some ex- 
cellent work in coloured training schools. Perhaps 
the Illinois training school stands first in the number 
of efficient leaders it has given to Negro women, and 
the devotion they have shared with their pupils; 
Miss Minnie Ahrens, in the Provident, Miss Sarah 
Ebersole, in the Freedman's, have records to be 
proud of, while their alma mater also claims Miss 
Lena M. Topping, whose work, even more than 
theirs, was an exploration into the unknown. 



The United Stales 197 

Spelman Seminary is the largest school for Negro 
women in the world, and was founded in 1881 by 
two New England teachers, under the auspices of 
the Baptist Home Mission Society of the North. 
In 1886 a department of nurse training was opened, 
though without equipment or hospital work, the in- 
struction being given by the teachers. In 1890, Miss 
Stevens, of the Massachusetts General, came for 
three years, followed by Miss Topping, who succeeded, 
after heroic efforts, in convincing the faculty that an 
entire reorganisation must take place for the pupils 
in nursing. She obtained a co-worker, Miss Lawson, 
from the Presbyterian in Chicago, and during sixteen 
years these two achieved the most heroic, consci- 
entious work of which nurses are capable. They 
succeeded in creating a real hospital, the Mac- Vicar, 
and in seeing their work soundly established, Miss 
Lawson directing the hospital while Miss Topping 
remained superintendent of nurses. In 1910, their 
course was extended to three years, and post-graduate 
work organised. 

Tuskegee has a good three years' course, and 
cannot meet the demands made upon it. Booker 
Washington writes: "From the first, training for the 
profession of nursing has been popular among the 
young women at Tuskegee, and there has been no 
occupation in which our graduates have met with 
more success or have been of more service, both to 
the members of their own race and to the white 
people of the South." 1 Tuskegee sent five nurses to 
the Spanish-American War. 

1 "Training Coloured Nurses at Tuskegee," A. J. N., December, 
1910, p. 167. 




198 A History of Nursing 

Coloured women make excellent nurses. To their 
natural gifts of tact and skilful handling are added 
soft, melodious voices, sympathetic natures, and 
idealism. They are especially successful in private 
duty and in district work, and are on the staffs of a 
number of visiting nurse associations. In the New 
York Nurses' Settlement the Negro nurses are held 
among the most valuable members, not only for 
good nursing, but for intelligent altruism. The 
Negro nurses of the country formed a national as- 
sociation in 1908, which is a vital force for their 
professional progress. These women have all the 
usual problems of the nurse to meet, with an addi- 
tional one the cruel handicap of race prejudice, 
springing, it must be, in the white race, from a sense 
of guilt. While the nursing community was small, 
it was free from this antisocial feeling, but as it 
grows, here and there barriers are put up, calling 
for pause and thought, that injustice shall not be 
done, at least, in the impersonal realm of education 
and state examination. 

Nurses' Journals. The American Journal of Nurs- 
ing and the yearly meetings of the Associated 
Alumnae together have supplied the central electric 
power which, at once feeding and being fed by the 
sources of energy in active groups and zealous in- 
dividuals the country over, made possible the very 
admirable achievements in collective action now 
standing to the credit of American nurses. 

Without co-operation, the journal could have had 
little influence; without the journal, the informing, 
inspiring monthly visitor, union would have been de- 



The United States 199 

layed and weak. The journal was first proposed by 
Louise Darche at the meeting of the American So- 
ciety of Superintendents of Training Schools for 
Nurses in Boston, 1896, and before the next, Miss 
M. E. P. Davis and Miss Palmer had made an ex- 
haustive inquiry into ways and means, interviewed 
publishers, and collected data of cost. But when, 
at Philadelphia, the plan of founding a national 
association of nurses took shape, it was felt that a 
national journal should be the first task of this more 
representative body. The Associated Alumnae took 
up the task at its first meeting in 1898 and Miss 
Nutting, Miss Palmer, Miss Harrington, and Mrs. 
Robb were appointed as the first Journal Committee. 
At the next meeting, Miss Davis, Miss Stevenson, 
and Miss Fulmer were added, and in January, 1900, 
the project was completed, the practical business 
details being carried through by the indomitable will 
of Miss Davis. 

A stock company was formed, no one outside the 
profession being allowed to hold shares, and it was 
determined that, as the national body became strong 
enough financially to buy over at least a controlling 
share of the stock, it would do so. The journal ap- 
peared in October, 1900, its editor, Miss Palmer, 
and her collaborators giving their services until it 
should be on a paying basis. At the end of one 
year its financial soundness was certain, and all 
doubt as to the ability of nurses to control and edit 
a national journal was past. 1 Ten years after its 

I " Short History of the Founding of the American Journal of 
Nursing," by M. E. P. Davis. Reports, International Conference 
of Nurses, Paris, 1907. 



200 A History of Nursing 

appearance its ownership by the national body was 
an accomplished fact, due chiefly to the sustained and 
generous gifts of local societies and of individuals 
whose shares of stock were turned in as gifts or who 
gave sums of money to the Journal Purchase Fund. 

In 1904, the nurses of California, encouraged by 
the success of the national journal, and feeling the 
immensity of their own section, established the 
Nurses 1 Journal of the Pacific Coast, which rapidly 
became the special organ of nurses' societies in the 
far West. Its first editor, pilot, and, we may say, 
creator, Miss Genevieve Cooke, started it, rescued it 
from the ruins of the earthquake, and set it upon a 
strong foundation. It upholds the highest standards 
and takes an advanced .position on the Woman 
Question. 

Another journal of national importance is the 
Visiting Nurse Quarterly, published by the Visit- 
ing Nurse Association of Cleveland. Among the 
quarterlies or monthlies of more local character, 
important ones are the Quarterly of the Illinois 
State Society and that of the Johns Hopkins 
Alumnae Association. 

The National Society. In its brief existence the 
national society of nurses, now the American Nurses' 
Association, 1 has accomplished some fairly large 
things in a very direct and simple way, with few words 
and no strife, deciding important undertakings as 
briefly and quietly as orders in the wards are given 
and taken. To the Journal Purchase Fund and the 
Isabel Hampton Robb Memorial it has added another 

'The articles were amended and name changed in 1911. 



The United States 201 

responsibility that of an endowment called the 
"Nurses' Relief Fund" for old age, accident, and 
invalidism, and in its fifteen years it has subscribed 
about $30,000 to these objects. The society is be- 
coming yearly more influential and more widely 
connected with other national bodies of women and 
men. Within its circle the superintendents and 
their graduates work side by side, and while the 
former often guide, they do so as individuals. Per- 
haps the most far-reaching thing the society has 
done in home affairs has been its election of an in- 
terstate secretary. The work done by this officer 
welds the whole country into one family and brings 
the experience of each section to the service of all. 
Two Western women have held this post : Miss Sarah 
E. Sly, of Michigan, first; and next Miss Isabel 
Mclsaac, for some years superintendent of the 
Illinois training school, and, in 1912, head of the 
Army Nurse Corps. 

War Service and the Red Cross. Up to the time 
of the Spanish-American War, the Red Cross Society 
of the United States had taken no concerted steps 
toward securing a skilled nursing service. Miss 
Clara Barton, its first president, a heroic, solitary 
figure, whose public service had begun in civil- war 
times, had accompanied the German ambulances in 
1870 and imbued herself so thoroughly with the 
principles upon which nursing relief at that time was 
based that she kept the volunteer character of 
such work unchanged. After her long presidency, 
the American Red Cross underwent a reorganisation, 
and then from its officers there came a recognition of 



202 A History of Nursing 

the new profession that must ever be gratifying to 
its members. 

The nurses themselves had some share in the affili- 
ation that resulted, as we shall briefly indicate. 

At their national meeting in 1898, Mrs. Robb 
brought the subject before them in her opening 
address, saying: 

... I wish to speak on a serious and unexpected ques- 
tion . . .; it is the attitude that this association shall 
take toward the present war. We all know that certain 
facilities are offered for securing care for the sick and 
wounded soldiers in connection with the Red Cross. 
At the same time we all appreciate the fact that, while 
it is an organised society, it does not represent the great- 
est or best skill in nursing in the country. We do know 
that our association represents numbers and skill, con- 
sequently it becomes your duty as delegates to decide 
whether you will offer the services of this association to 
the Government of the United States, to care for its sick 
soldiers at any time you may be called upon during the 
continuance of the war. . . . 

Last spring when possibilities of war menaced the 
nation, individual nurses offered their services ; but, un- 
fortunately, trained nurses were not the only women so 
impelled, as applications and offers to do army nurs- 
ing poured into the Surgeon- General's office from all 
manner of women, from the well-meaning "born-nurse" 
to the enthusiastic patriot, from sisterhoods and from 
adventuresses. 

This association having offered its services, the vice- 
president and I went to Washington and had a per- 
sonal interview with the Surgeon-General. But our 
mission was a failure, as we were told that the nursing 
department had been given into the charge of the 



The United States 203 

Daughters of the American Revolution, with a woman 
physician as director (Dr. Anita Newcomb McGee). 
Visions of what splendid systematic work might be done 
if the nursing might only be in the hands of the nurses 
themselves, supplemented by the extra supplies so 
generously provided by the D. A. R., the Red Cross, 
and other societies, floated before us, but it was not to 
be. The chaos and confusion that reigned supreme at 
first, owing to the suddenness and greatness of the emer- 
gency, were intensified and prolonged by the lack of 
experience on the part of those into whose hands the 
work was entrusted. This, and the appointments made 
from all varieties of women mentioned above, resulted 
in much bad nursing, a worse morale, and in a total lack 
of standard or system. [The first nurses employed by 
the American Medical Department were sent to Florida 
on May 10, 1898. Thereafter there were from one hun- 
dred to twelve hundred nurses in the employ of the 
government.] How long such a condition would have 
continued to exist it is hard to say, had not the situation 
been saved by the assistance and admirable work ren- 
dered by Red Cross Auxiliary No. 3. 

A brief word in explanation of these auxiliaries. They 
did not form a permanent part of the American Red 
Cross, but were made up of a number of patriotic men 
and women who organised for the purpose of raising funds 
to assist the government in any way, and to relieve the 
needs and suffering of the sick soldiers. After the war 
was over, they disbanded. Auxiliary No. 3 was organised 
for the express purpose of supplying and maintaining 
trained nurses in army hospitals. Too much cannot be 
said in praise of the work it accomplished, hampered as 
its members were by being only auxiliaries and not the 
controlling head. It was through this auxiliary that 
the best nursing was done. It put itself at once in touch 
with trained nurses of experience and ability, and con- 



204 A History of Nursing 

tinued to co-operate with them to the end. But with 
lack of experience at the head of the service and with 
nurses recruited from a variety of sources, there was 
necessarily much chaff among the wheat. 

A certain amount of good nursing was done, but not 
half of what could have been accomplished with proper 
management. Many good nurses who went into the 
army hospitals in the summer returned home, because 
they could not tolerate the lack of discipline and the 
looseness of work and conduct, or because they could 
not conscientiously serve under the young, inexperienced, 
and indiscreet women placed over them. Do not 
understand me as saying that all was unsatisfactory, 
for, just when the stress was greatest, the superintendents 
with their nurses, chosen by the Red Cross Auxiliary 
No. 3, did much to minimise the lamentable state of 
affairs which had existed at that time. 

Superintendents of note who took charge of army 
nursing during the war were Miss Irene Sutliffe, 
then at the New York hospital, who went to Camp 
Black; Miss Anna C. Maxwell, who was given leave 
of absence from the Presbyterian to organise the 
typhoid camp at Chickamauga; Mrs. Lounsbery, 
who followed her there; Mrs. Quintard, who had a 
long service in Cuba and elsewhere, and others. 1 

Miss Maxwell, whose record was especially dis- 
tinguished, but who rarely speaks or writes of her 
work, has been persuaded to contribute for this 
volume the following account of her army experience. 

1 The Order of Spanish-American War Nurses was suggested by 
Dr. McGee and formed in 1898-99. The committee on organisation 
was Mrs. Lounsbery, Miss Hibbard, and Miss Hodson. The first 
meeting was held at the New York hospital, when five hundred 
members enrolled. 



The United States 205 

Though short, it duplicated some of the incidents 
of Miss Nightingale's work in the Crimea. 

Soon after war was declared between Spain and the 
United States, it became known that the soldiers in the 
different Camps of Instruction, where epidemics existed, 
were suffering from lack of nursing. Through the ac- 
tivity of the Third Auxiliary of the Red Cross, a fund of 
one hundred thousand dollars was soon available, the 
Surgeon- General finally persuaded to send nurses through 
the established channels to the different camps, and 
it was my good fortune to be appointed Chief Nurse 
at Sternburg Hospital, 1 Camp Thomas, Chickamauga 
Park, Georgia. 

Imagine a beautiful park, under the shadow of Look- 
out Mountain, partially surrounded by the historic 
Missionary Ridge, with perfect roadways, adorned by 
shrubs and trees from many climes, with here and there 
a monument marking the bloody contest that had taken 
place upon that field during the Civil War ! Amid these 
picturesque surroundings, Camp Thomas was established 
and about fifty thousand of our volunteer troops were 
encamped there. 

Early in July, Colonel John Van Rensselaer Hoff took 
charge, relieving Colonel Hartseff. The condition of the 
camp was found to be unsanitary, and Chickamauga be- 
came a by-word for all that was bad. Colonel Hoff has 
described the situation as serious, typhoid fever was epi- 
demic, and the division hospitals, never intended for such 
purposes, were unable to care for such cases. He felt 
the urgent need of a "cleaning hospital" large enough 
to take a thousand patients, telegraphed his views to 
the Surgeon- General and secured the needed authority. 
The next is told in his own words: 

1 Named for the Surgeon-General. 



206 A History of Nursing 

"While I was wondering where I was to find a trained 
nursing force to care for the many serious cases, Miss 
Cromeline (now Mrs. Lee) came to Chickamauga as 
the representative of the Red Cross, and requested per- 
mission to supply the nursing staff for the new hospital. 
This was indeed a relief to my mind, and with the ap- 
proval of the Surgeon- General the offer of the Red Cross 
was accepted. 

"I can only add that I shall never be able fully to 
express my sense of relief, when you and your nurses 
took charge of the service at Sternburg hospital." 

As a matter of fact, the mortality rate at Chickamauga 
bears testimony to the good professional work done there 
in spite of the adverse circumstances. The population 
ran close to 50,000 men, many more than in any other 
camp. The death-rate from all causes was eighteen 
per thousand. The rate at Jacksonville was twenty- 
six, and at Alger and Meade twenty-one and eight- tenths 
per thousand. 

The Surgeon-General's report gives a word about 
Sternburg hospital: capacity seven hundred and fifty 
beds, fifteen medical officers, one hundred and sixty- 
seven trained nurses, seven non-commissioned officers, 
and one hundred and seven private hospital corps. 

The first instalment of the nursing staff, twenty-six 
in number, went to Chattanooga, July 26th. While 
waiting the completion of the hospital, we visited the 
division hospitals at Chickamauga, and the horrors 
that met our eyes will never be forgotten. Sick and 
dying men lay unattended, exposed to the sun's rays, 
beyond the limits of the tents, covered with flies, sur- 
rounded by unwashed utensils, dust, and dirt. 

The situation was desperate, but delay in opening the 
hospital was due to the fact, that only one railway 
company was employed by the government to bring in 
supplies. We found dishes, lamps, medicine glasses, 



The United States 207 

and all bed supplies, except rubber sheeting. About 
half the necessary amount was secured from the commis- 
sary. Soldiers' ponchos had to be pressed into service, 
and when these were exhausted, the infected mattresses 
had to be burned. 

The beds made ready, the cars containing utensils ar- 
rived, and it was decided to receive two hundred patients 
on the second of August. They came, two in an am- 
bulance; the black procession could be seen stretching 
through the park for over a mile. Most of the patients 
were started hours before, and their condition on arrival 
can better be imagined than described. Many were 
wildly delirious, their burning bodies in a filthy condition, 
dead flies were found embedded in the coatings removed 
from their mouths, and there were numbers with bed- 
sores of a magnitude unknown in the present day. 
When these two hundred sick men were deposited in 
their beds, what was my horror to find the supply of 
milk and nourishment insufficient for the night (we sup- 
plemented it by the foods we had brought in our trunks). 

But one sink for the disposal of discharges had been 
dug; the bed-pans and other utensils were not yet un- 
loaded from the train that brought them. I was informed 
by the commissary that it was after six o'clock, that all 
work was suspended for the day, and the utensils could 
not be unpacked until the next ; moreover, that inventories 
and requisitions would be required before they could be 
put into use. The authorities were then informed that 
I would open the cars by force, if necessary, rather than 
expose our already over-worked nurses to the dangers 
of infection. They yielded, the cars were unloaded, and 
a line of nurses formed to carry the supplies to their 
tents, so that our patients could receive the proper care. 
No adequate water facilities were provided, although I 
was informed that the government could have secured 
a pure water supply for the entire camp, by paying for 



208 A History of Nursing 

the use of the water of Crawfish spring, just outside 
the park. For days the water was brought in hogs- 
heads insufficient for our needs. Cold water was later 
piped into the camp, and after three weeks I learned, 
through a member of the engineer corps, that a hot- 
water plant could be readily constructed : this was done 
within thirty-six hours after the requisition was signed. 

The laundry work for the camp was contracted for by 
a firm in Chattanooga, and so little conception had they 
of the work before them, that they sent a boy with a 
mule and cart to remove a tent full of soiled linen. I 
personally listed these clothes (over eight hundred pieces), 
the condition of which was indescribable. 

Only one pound of carbolic was found, chloride of lime 
was secured at Chattanooga, and linen was much dam- 
aged by its use. The trenches between the tents, and 
the ground, saturated with typhoid bacilli, where the 
buckets stood, were finally disinfected, but not until 
the entire camp had been exposed to the infection from 
the millions of flies that gathered about these spots. 

The equipment, except that there was no crematory, 
was generous, and after the sixty-cent ration was declared, 
the food for the patients was sufficient. 

The chief difficulties arose from lack of proper admin- 
istration. As an example of the hopeless confusion, no 
provision was made to record or place in safety the 
money and valuables of the sick soldiers. The beds 
were not numbered, the sections were not lettered, al- 
though numbers and letters were prepared before we 
arrived. The valuables were difficult to trace, and the 
patients got lost, because there was no method of identi- 
fication. Sentinels had to be placed over the linen, 
because of the slow return from the laundry. 

The nurses were sent to the camp by Dr. Anita New- 
comb McGee, appointed by the Surgeon-General as 
Chief of the Nursing Staff. On requisition made to 



The United States 209 

Washington, quarters, maintenance, and travelling 
expenses were provided by the Third Auxiliary of the 
Red Cross. Every part of the United States was repre- 
sented, and I cannot speak too warmly of the splendid 
self-forgetfulness, self-sacrifice, and devotion shown by 
the nurses who worked uncomplainingly through the long 
hours, amid many physical discomforts, under a broiling 
August sun, unrelieved by even a passing breeze. 

As each detachment of nurses arrived, the conditions 
of hospital and camp life were explained. A head nurse 
was placed in charge of each section (10 tents; 40 beds), 
and day and night staffs provided as the severity of the 
cases demanded. 

All being graduated nurses it was urged that we work 
harmoniously under authority, that we set standards by 
which we could prove our fitness to undertake patriotic 
service for our country, that our best effort was expected 
as the public would judge us critically, that we must 
"make good," as the future of army nursing lay in our 
hands. I must truthfully record that there were fail- 
ures, as in all human lives. To our deep regret, some 
were not strong enough to withstand the temptations of 
camp life. 

One of the greatest privileges was helping to fit out the 
hospital trains that carried the regiments back to their 
homes. The New Hampshire regiment took home 
our sickest men, many of them at the point of death. 
I was not permitted to furnish nurses from our own 
corps, so offered the services of three sick nurses "going 
on furlough" till others could be procured en route. 
As no relief was secured, these nurses worked constantly, 
forty-eight hours, and helped to bring every man through 
to his home alive. 

Unfortunately, fourteen of our corps contracted ty- 
phoid fever. They w r ere sent at once to their homes, 
and all recovered save one. 



VOL. III. J 



210 A History of Nursing 

Late in August the regiments were ordered away, and 
as they departed, our hospital corps men were daily 
being thinned out. Washington was asked to supply, 
and declined. The commanding officer, when appealed 
to, laughed, saying: "You have had everything you have 
asked for," and although he had previously criticised 
my over-working the nurses, he refused to give us help. 
He was informed that the nursing staff could not be left 
helpless, with over five hundred sick men to care for 
without orderlies, and that several millionaires stood 
ready to furnish orderlies to the camp if the government 
would permit. Otherwise I would be obliged to ask to 
have the nurses withdrawn at once. Within twenty- 
four hours the commander sent the orderlies, who proved 
themselves most efficient. 

The fine courage of the soldiers, who gave up their 
lives without tasting the glory of battle: the courtesy 
and kindness shown us by the officers and medical staff, 
the generosity of the multitude of societies and friends 
who overwhelmed the camp with supplies, filled us with 
admiration, and I regret that space forbids a more fitting 
tribute. 

[Miss Anna Maxwell, Senior Superintendent of 
Nurses in the United States, organiser of the St. Luke's 
and Presbyterian schools in New York City, has been 
at the head of the latter for some twenty years. Well 
known and justly famed for her perfection of standard and 
method in training, she is even more exemplary in the 
generous wealth of helpfulness toward the individuals 
who come within her radius. Miss Maxwell was trained 
at the New England Hospital for Women and Children. 
In collaboration with Miss Amy Pope, one of her assist- 
ants, she has written a standard text -book on nursing.] 

As a result of the war experience, the leading 
superintendents of the country determined to make 




Anna C. M 
Superintendent of Nurses, Presbyterldfl Hospital 




The United States 211 

every effort in their power to bring an efficient army- 
nursing service into being, and for many of them, 
this subject filled every free moment by day and 
far into the night, with the most laborious de- 
tails of correspondence and study. 'While lead- 
ing nurses were pondering over the possibilities 
of working out a creditable army-nurse service on 
a right basis," said Mrs. Robb at the second an- 
nual convention, 'the women and men who had 
been active in the auxiliary work were also ponder- 
ing the same thing, and there were among them 
not a few who were willing to continue their la- 
bours to this end when once satisfied that nurses 
of the right status were willing to take up this new 
field of work." 

In December, 1898, in the training school of the 
New York hospital, Mrs. Winthrop Cowdin, Mrs. 
Whitelaw Reid, and others prominent in the war 
relief work met the executive committee members of 
the Associated Alumnae to confer on plans for secur- 
ing a permanent army-nurse corps. As a result of 
this conference a joint committee was chosen to draw 
up a bill to present to Congress. The nurses placed 
on it were Miss Irene Sutliffe, Miss Maxwell, Miss 
Wadley, Mrs. Robb, and Miss Eleanor M. Wood. 
Space forbids our following the ups and downs of 
the army-nursing bill. It finally passed Congress 
in February, 1901, and Mrs. Dita H. Kinney, a 
graduate of the Massachusetts General, was placed 
at the head of the army nurses, serving until 1910, 
when she was succeeded by Miss Jane A. Delano, a 
Bellevue woman, who had had a varied and eminent 
career in nursing^ including the superintendency of 



212 A History of Nursing 

her own alma mater. T After two years, Miss Delano 
withdrew to give her services to the Red Cross. 
The army-nursing bill had met the opposition of 
the older leaders of the Red Cross, but the support 
of those who held to the newer ideas, and after re- 
organisation an informal committee of prominent 
nurses went to Washington to visit its officers, and 
ask that some sound basis for Red Cross nursing be 
sought. Their suggestions were well received and, 
an informal conference was held in New York in 
February, 1904, between Red Cross officials and 
nurses. From these meetings grew a final close 
relation, and on December 20, 1909, the Red Cross 
War Relief Board appointed a Central Committee 
on Nursing Service, on which ten nurses were placed. 
Miss Delano was made chairman of this central 
committee, the Red Cross Bulletin for October making 
this comment: 

By this arrangement the whole system of the Regular 
Army Nursing Corps and Red Cross Nursing Corps will 
be placed under one head, so that in case of war the plans 
for Red Cross nursing assistance will fall into complete 
accord with the- demands of the army medical service. 
Miss Delano will, therefore, be not only fully advised 
as to the regular nursing strength of the army corps, 
but will know exactly the status of the volunteer aid 
of the Red Cross Nursing Corps. 

y 

Under the new plan state groups form branches 
of the Red Cross, and in each state a committee, on 

1 See Nursing in the U. S. Army, by Dita H. Kinney, Superintend- 
ent, Army Nurse Corps. Reports, International Council of Nurses, 
Berlin, 1904. 



The United States 213 

which leading nurses are placed, is charged with the 
enrolment of nurses for service. It will be seen, by 
comparison with foreign provisions for the nursing 
service of the Red Cross, that in no other country 
have nurses been met upon a higher plane or more 
honourably treated with as allies and co-workers by 
Red Cross officers. 

Following the example of the army, though slowly, 
the navy established a nurse corps by Act of Congress 
in May, 1908. Five years before, Medical Director 
Boyd had drafted a bill which, had it passed Congress, 
would have secured advantages that must now be 
gained slowly. It failed, and the bill of 1908 owed 
its success largely to the efforts of Admiral Presley 
M. Rixey, who, when it finally passed, was Surgeon- 
General of the Navy. He was a firm advocate of 
nursing service, and for six years worked steadily to 
overcome the prejudice against it that was cherished 
by many of the older naval officers and, also, many 
of the naval physicians. The first Superintendent 
of Nurses for the Navy, Miss Esther V. Hasson, was 
appointed in August, 1908, and the first twenty 
nurses were soon after detailed to duty at the Naval 
Medical School Hospital in Washington. It is not 
anticipated that nurses will ever be placed on w r ar 
ships, though it is expected that, in time, they will 
be assigned to duty on all hospital ships. They will 
serve in the shore hospitals, of which there are 
eighteen or twenty in the navy. * 

Social Service- -The most prominent variation 
from the old to the new type of nursing is that called 

1 "The Navy Nurse Corps," A. J. N., March, 1909. 



214 A History of Nursing 

"social service" (the word "service" being a current 
technical term in use in hospitals), as distinguished 
from institutional service. The term arose naturally, 
yet we may ask whether Miss Nightingale's expres- 
sion "health nursing" is not truer and more self- 
explanatory. For the new, rapidly multiplying lines 
which are broadening the nurses' horizon and en- 
larging her fields, setting, at the same time, a new 
standard by which she is to be measured, all tend to 
the prevention of illness and its ensuing wretchedness 
by the intelligent nurture of health and health- 
making conditions. Under this influence the nurse 
is rapidly being "socialised"; made a part of a com- 
munity plan for communal health, and, in addition 
to her professional equipment, which now, more than 
ever, must be of the best, she is called upon to show 
much knowledge of a very different, yet related 
kind, attainable only through a truly "higher edu- 
cation." Besides her technical skill, dexterity, and 
practice in observing and interpreting physical symp- 
toms, she must acquire a social skill in observing 
and interpreting social symptoms, directly linked as 
they are with the physical destiny of the individual 
patient. 

All divisions of social service are found in embryo 
in the daily round of visiting nurses, and it has been 
chiefly due to their initiative that many now highly 
organised specialties have been developed from their 
daily tasks. We have said that the nurse is rapidly 
becoming socialised; it is good to know that she has 
had much to do with bringing this about. It is 
significant that, in countries where the district 
nurse is closely subordinated as the arm of a con- 



The United States 215 

trolling body, she remains a strictly ameliorative 
agent, submitting silently to unjust social conditions, 
but that where she is able to exert initiat've she tends 
to an original upbuilding of work along preventive 
lines, and makes protest against wrong. The new 
motive power is civic intelligence, closely akin to the 
mission spirit, but with a different symbolism and 
direction. Instead of proselytirg with reference to 
another world, it educates for useful, happy, and 
honourable citizenship in this, leaving to each the 
religion of his choice. Yet it is not a contradiction 
of any other ideal, but the sum total of all. 

The lay world already had its pioneers in this path : 
Arnold Toynbee, Jane Addams, and the College 
Settlements, but they had never been heard of by 
a young probationer from Rochester, Lillian D. Wald, 
when she went to the New York hospital in the days 
of Miss Sutliffe's sunny influence there. Young and 
inexperienced, with an indulged and petted girl's 
family life behind her, Miss Wald seems to have had, 
in entering the hospital, no more conscious purpose 
than abounding energy of mind and body and an 
overflowing good-will. After training, she, one day, 
followed a tenement-house mother to her home and 
there experienced what she has called her ' ' spiritual 
baptism." The impression received gave direction to 
her life, and in 1893 she persuaded one of her class- 
mates, Miss Mary Brewster, to go with her into 
the most crowded tenement-house quarter to live. 
(The support of the two was guaranteed by friends 
and the entire subsequent development has been 
financed by voluntary gifts of individuals or groups.) 
Only then did they learn of the existence of settle- 



216 A History of Nursing 

ments. Now the one that has grown from their little 
fifth-story flat is as notable in its different way as 
Hull House. 

The first time that Miss Wald described her work 
to nurses was in 1901, and from that earliest account 
we quote those parts which especially interest them: 

About eight years ago tenement-house life in its most 
pitiable aspect was presented to me. I had been giving 
a course of lessons in home nursing to a group of prole- 
tarians from the older world a people who find a re- 
newal of hope in New York, if not for themselves, at 
least for their children. One morning, one of the women 
of the class was not present and her little daughter came 
to ask me to call upon her mother, as she was ill. Despite 
my experience in a large metropolitan- hospital, and the 
subsequent knowledge gained through a year's residence 
in a reformatory and asylum for the waifs of New York, 
the exposure of that rear tenement in the lower East 
Side was a most terrible shock a shock that was at 
first benumbing. . . . 

Upon further acquaintance with the house and neigh- 
bourhood, I learned that kindly intention from the out- 
side had not been wholly absent. The visitor from a 
medical dispensary had called, and, touched by the 
poverty of the place, had sent a bottle of beef extract 
with the directions for use printed on it, but there was 
no one in the house who could read English. Other 
charitable persons had sent coal ; but my nurse's instinct 
revolted at the knowledge that nobody had washed the 
woman, made her bed, or performed any of the offices 
that every human creature should feel entitled to in like 
condition. I will not take time now to describe all of 
the circumstances, nor my reflections on the responsi- 
bilities of the community, as they appeared to me, to 










Lillian D. Wald 

Founder of the Nurses' Settlement, New York City. Taken during train 

New York Hospital 



he 

Pub//, 




The United States 217 

this one family. To me, personally, it was a call to live 
near such conditions. . . . 

To a friend the plan was suggested : ' Let us two 
nurses move into that neighbourhood let us give our 
services as nurses let us contribute our sense of citizen- 
ship to what seems an alien community in a so-called 
democratic country." . . . Having formulated some 
necessary details of the plan, we proceeded to look for 
suitable quarters, and in the search discovered the 
"settlement." 

The life possible through making our home among 
the people in a simple, informal way, led us easily and 
naturally into all the questions that affected them. 
Through our visits to the children and our interests in 
their general welfare, we learned of the unsatisfactory 
school conditions and of the absurdity of a compulsory 
school law when there was not adequate school accom- 
modation for the children. Such knowledge as came 
to our notice, such effective protest as would illustrate 
the conditions of our neighbourhood, was brought before 
a suitable public, individuals, or societies especially 
concerned, whenever occasion could be found or made. 
The women on the lower floors in the tenement where 
we lived were employed in the needle trades, and un- 
bearable treatment at the hands of a foreman had moved 
them and their fellow-workers to agitate for trade or- 
ganisation. In the search for some one of their own sex 
who could speak for them, in what they called "better 
English," they came to us, and that was our first intro- 
duction to the protest of the workers which is expressed 
in Trades-Unionism. 

A semi-official recognition by the Board of Health 
gave us the privilege of inspection of the tenements, and 
valuable information was thus stored up toward the 
housing problem. The experience thus gained had its 
share of influence in the general education of the public, 



218 A History of Nursing 

which later led to the Tenement-House Exhibit; to the 
appointment of a Tenement House Commission under 
Governor Roosevelt, and a final creation of a separate 
department for the city of New York. One of the 
members of the settlement [Miss Wald], took active 
part in the movement, and was one of the two women on 
the jury of awards for plans of model tenement houses. 
Through her efforts to obtain a legacy that had been 
bequeathed for a fountain somewhere in the city, the 
Schiff fountain was erected in the neighbourhood of the 
settlement, and was the strong influence in deciding an 
adjacent site for a park and public playground, to make 
place for which no more congested and unsightly rook- 
eries could have been demolished. 

To meet the rightful demand of the children for play > 
we conducted in our yards one of the first playgrounds in 
the city. It was an experimental station, in a way, as 
well as an enlightenment of the general public, and was 
instrumental in helping to develop public feeling in the 
matter. 

The workers of the settlement can look with gratifica- 
tion upon the increasing interest in public-school matters 
affecting their neighbourhood as in part the result of 
their efforts to bring public attention to the lack of room 
for the children in the schools and to bring the interests 
of their localities directly to school boards. One of the 
household was for a time a school inspector, but, whether 
in official relationship or not, the members have been 
frequently consulted by those in authority on the Board 
of Education. 

From the needs of the neighbourhood has sprung the 
service that we call "first aid rooms," in several 
crowded quarters. In each one a nurse is in attendance 
at certain hours of the day, and cases that require 
dressings, fresh cuts, old wounds, simple eye cases, ec- 
zemas, etc., are treated. These are such nursing cases 



The United States 219 

as might be attended to by the members of the families, 
if the mothers had sufficient leisure or knowledge. Many 
of them are sent by the physicians of the large dispen- 
saries who have not confidence that the parents will 
apply ointments, dress wounds, or syringe ears daily 
and in a cleanly way. These are often school children, 
and the nurse is thus able to care for a greater number 
than would be possible if she went to them. This work 
has also a direct bearing on the school attendance of the 
children, and though many of the cases are not important 
from a medical point of view, they are of the utmost 
importance from the educational standpoint, as the 
children are sent home by medical school inspectors, 
and, not being allowed to re-enter while the trouble con- 
tinues, often miss much precious school time, for it must 
be remembered that few of these children can attend 
school after fourteen; at that age they all begin wage- 
earning. As an illustration, I knew of a lad of twelve 
years who had never been in school because of eczema 
of the scalp. True, the mother had gone to dispensaries 
and obtained ointments, but the over-driven, worn-out 
woman said they did no good. [The school nurse was 
not then in existence.] Careful epilation, systematic 
disinfection, and application of the medicament were 
so successful that, when school opened in the fall, I had 
the pleasure of placing the boy there for the first time 
in his life. 

Our nursing work is the reason for our being, and from 
it all our other activities have had a natural and unforced 
growth. W-e conceive the underlying thought of the 
district nurse to be that of neighbourliness, and plan to 
have each nurse work in a small district in close touch 
with the settlement house that she belongs to, that re- 
course may be had to it in emergency as quickly as 
possible. . . . 

The various needs of the patient are kept vividly in 



220 A History of Nursing 

mind. From what we call the "settlement point of 
view,' 1 we believe that the patients should know the 
nurse as a social being rather than as an official visitor, 
and that all legitimate relationships which follow from 
her introduction as nurse shall be allowed to take place. 
It is good from this point of view that the patient should 
know the home of the nurse, and that the latter should 
be intelligent about the housing conditions, the educa- 
tional provisions, and the social life of the neighbour- 
hood in which she works and lives. From this motive 
has come the opportunity for the settlement to show 
where the neighbourhood has been neglected, and to 
bring into communication the different elements of society 
that go to make up a great city. We think and feel 
sincerely that the relationship is reciprocal, that we are 
partaking of the larger life, that society in general has 
closed the avenues that lead to this knowledge, and that 
the different elements of society need one another. . . . 

The part that Miss Wald herself came to take in 
public affairs of moment and the remarkable prestige 
that she gained as a leader in all manner of civic, 
t ducational, and humanitarian movements can hardly 
yet be told in full, even did our space permi . But 
there is no doubt that, in the future, her name will 
rank with those great nurses of the past, whose 
activities far outran the single service of aid to the 
sick. For, beginning as an obscure visiting nurse, 
she has come to be called into consultation with the 
members of one city administration after another; 
has sat on varied public commissions; counselled 
with a governor about the immigrant; interfered 
successfully with a President and his Cabinet in behalf 
of a Russian refugee; and addressed a committee of 
Congress on the need of saving the nation's children. 



The United States 221 

Perhaps, as nurses, we may take especial pride in 
knowing that the suggestion of a Federal Children's 
Bureau was first hers, as well as much of the most 
persuasive work carried on in its behalf. * 

In 1900, a similar group was led by Miss Cabaniss 
and Miss Minor in Richmond. The settlement which 
they built up there is a rare example of co-operative 
work. The rent of a suitable house was covered by 
letting rooms to private nurses, they, in turn, 
promising to give certain portion of their time to the 
district nursing, while the additional calls were at 
first met by the members of a class of pupils in the 
Old Dominion hospital, who gave all their hours and 
afternoons off duty to the district patients. Miss 
Cabaniss, during her years in the hospital as super- 
intendent of nurses, had so thoroughly imbued her 
pupils with altruism that, when she withdrew to the 
settlement, her graduates were ready to help in any 
and every way. Little by little a permanent salaried 
staff has been built up and the work developed in 
every direction. Here, too, the residents aimed at 
taking a share in civic affairs. The character and 
social standing of the two founders, their serious 
purpose and trained judgment, qu'ckly gave them 
great influence, and they have made the settlement a 
centre for progressive movements of all kinds. There 
was brought about the first affiliation of the various 
charities, and a room given for a Charity Organisa- 
tion office. 

Their first large undertaking was the improvement 
of the almshouse nursing service. This, indeed, 

1 For full details see Handbook of Settlements, pub. by Russell Sage 
Foundation 1911, pp. 205-211. 



222 A History of Nursing 

had been projected by Miss Cabaniss in her hospital 
days, and now they persuaded the authorities to let 
them engage good, reliable women as attendants, for 
whose training in the wards they would themselves 
be responsible. It was hoped that by beginning in 
this way a definite improvement might be gradually 
attained. The experiment went well enough until 
it came too close to political interests. 'When we 
solicited the committee from the City Fathers for 
their support of a regular code of hospital regulations" 
(wrote Miss Cabaniss), "a perfect howl went up, and 
we were remonstrated with for casting slurs upon a 
branch of municipal government which, up to the 
time of our speaking, had escaped all suggestion 
of corruption; . . . when the physician-in-chief re- 
tracted his agreement to assist his juniors, our in- 
ternes, in instructing our class of pupils, our plans 
collapsed." 

During the first year, a diet kitchen and loan 
closet were opened, classes in home nursing started, 
and a number of clubs for working women and boys 
formed. We cannot try to describe the later growth 
in all directions. Nurses' settlements have now 
become firmly established in Orange, San Francisco, 
Hartford, and elsewhere, making themselves felt in 
housing and living problems, questions of public 
sanitation and hygiene, and bringing nurses into 
direct contact with the modern world of industrialism, 
and the workers who inhabit it. 

On the Western coast, visiting nursing was first 
suggested by Miss Eugenie Woods, a nurse who went 
into it herself, followed by Octavine Briggs. The 
latter first started a settlement, which has taken in a 



The United States 223 

number of neglected children to live. Miss Aimee 
de Turbeville, between private cases, gave her 
services free to visiting nursing, finally building up a 
full service. Through her efforts there were obtained 
a day nursery, a dispensary, free baths, and a country 
home for children. Telegraph Hill, the newest 
settlement, was founded by Miss Betty Ashe, who, 
beginning with an interest in children, went to 
the Presbyterian in New York to be trained under 
Miss Maxwell, in order to equip herself more fully 
for social work. Under her buoyant and broad- 
minded leadership, all kinds of social and nursing 
service are carried on, and a comprehensive view 
of the needs of the city as a whole is maintained. 
The visiting nurses of San Francisco were made 
auxiliary health inspectors, and the enactment mak- 
ing tuberculosis reportable there was brought about 
by a nurse. 

Briefest mention only can we give to the original 
work built up by Miss Lydia Holman in the mount- 
ains of North Carolina, first in living as a nurse among 
the mountaineers under the wildest circumstances of 
remoteness, with no doctor less than thirty miles 
away ; then travelling to the cities to gather resources 
for her little hospital. 

Public-school nursing, one of the most vigorous of 
the new specialties, has owed its beginnings almost 
always to the promptings of the visiting nurse. It 
was the English example that determined Miss Wald, 
a friend of Miss Hughes and Miss Morten, to carry 
it to the schools of New York. Already Miss Wald's 
reports to the health officers on contagions in the 
schools had had a share in bringing about the medical 



224 A History of Nursing 

inspection, and the opportunity to introduce the 
nurse came in 1902, when Dr. Ernst Lederle was 
appointed Health Commissioner, for he came almost 
at once to her to ask how the service might be im- 
proved. Her instant reply was: 'Put the nurse 
there to round out the doctor's work," and this answer 
was accompanied by an offer to loan a settlement 
nurse on salary for a month's experiment. The 
story of this trial, carried out by a gifted and tactful 
woman, Miss Lina L. Rogers, from the Toronto 
Hospital for Sick Children, has been fully told else- 
where. J Miss Wald and Miss Rogers were soon 
called to other cities to tell of school nursing, and the 
visiting nurses of Philadelphia, Baltimore, Chicago, 
and other places quickly formed in line to help start 
similar work. 

Of the many instances where assistance has owed 
its inception to the visiting nurse must be mentioned 
the recent first undertaking of a life insurance com- 
pany 2 to supply visiting nurses to the holders of its 
industrial policies. This provision, though still in 
its experimental stage (1912), has spread to the larger 
cities of many of our states, and to several in Canada, 
and has multiplied the calls upon visiting nurses by 
the thousands. The original idea as well as the plan 
of execution came from Miss Wald, who laid the pro- 
ject before Dr. Frankel, one of the chief officers of the 
company. It was by her advice that the nursing 
service was secured by contract made with existing 
visiting-nurse organisations, rather than by the in- 

1 Visiting Nursing in the United States, by Yssabella G. Waters, 
1909, and A. J. N. files for 1902-1903, el seq. 

2 The Metropolitan Life. 



The United States 225 

stallation of a separate staff. Whether this con- 
nection will be permanent is a matter for time to 
tell. It is enough now to remember that, in drawing 
up this project, Miss Wald had the largest possible 
view of bringing the nurse to a vast body of small- 
salaried people who needed her. The limitat ons 
incident upon the competitive system and private 
profits are at present the only shadows upon the 
bright possibilities of a comprehensive scheme for 
providing skilled nursing for people of moderate 
means. It is clear that a danger lurks in private 
interests, for, as the nurse used to be exploited to 
lead patients into the church, now she might ob- 
viously be used to decoy clients into this or that huge 
financial concern. However, the present A ast ex- 
tension of insurance nursing suggests a future when 
all such service may be carried on by the people 
themselves, under public ownership. 

For a number of years, nurses in this as in other 
countries had been making individual excursions off 
the beaten track of professional work. In 1900, 
Mrs. Von Wagner, of St. John's hospital, Yonkers, 
was made sanitary inspector, under the Board of 
Health in that ity. The Civic League and Woman's 
Institute there had first employed her in this capacity 
as a demonstration, and their spirit and determina- 
tion carried her finally into the official position, for 
which she was rarely fitted by capacity and enthusi- 
asm. She won it after a stubborn contest, and wrote : 

'Landlords, politicians, and employees (of the de- 
partment) all fought against the woman inspector, 
and but for the members of the board and Miss 

M. M. Butler, president of the Woman's Institute 

VOL. III. IS 



226 A History of Nursing 

who overcame all opposition, the appointment 
would not have been made." In 1904, Miss Mary 
M. McVean, a nurse from St. Luke's, New York, 
was appointed as a tenement -house inspector. 
Miss Annie Darner of Belle vue and Miss Mildred 
McKnight, of the Illinois training school, were 
probably the first nurses to take positions as agents 
for Charity O ganisation societies. Miss Menia S. 
Tye, of the Toronto General, was the first to take a 
domestic science degree. Miss Annie E. Kennedy 
was the pioneer in pure-milk-station work, having 
been selected while still a pupil in the Rochester 
City hospital to enter a municipal milk station, under 
the direction of Dr. Goler, who has since become 
known over th2 world for his work in this direction. r 
The instructive care of expectant mothers was first 
tried out in Boston, while a nurse to watch and teach 
mothers after confinement was appointed by Dr. 
Goler's efforts in Rochester in 1911. Supported by 
a voluntary society, she has headquarters in a public 
school, and co-operates with the health officers and 
all other agencies. In 1901, nurses first began 
taking the summer course of the School of Philan- 
thropy maintained by the Charity Organisation 
Society of New York City. Whole groups entered 
into the crusades against preventable diseases; the 
Chicago visiting nurses, one of the largest and most 
important of such groups, were endowed by the 
courts with powers of sanitary inspectors and pro- 
bation officer . The Johns Hopkins alumnae took 
up the anti- tuberculosis work, and Miss Reiba Thelin 

111 Nurse's Work in Milk Stations." George W. Goler, M.D., 
American Journal of Nursing, March, 1904, p. 417. 



The United States 227 

offered her services for house-to-house visiting and 
teaching. The state society of nurses there gave the 
salary for a tuberculosis nurse; in Buffalo, the City 
Council gave the visiting nurses sanitary inspectors' 
badges, and asked them to report bad housing con- 
ditions. The Alice Fisher alumnae offered their 
services to the officers of Juvenile Courts. Some of 
the ablest and most devoted of women, prominent 
among whom were Mrs. Quint ard in Philadelphia 
and Mrs. Gretter in Detroit, gave up superintendents' 
positions to go into district-nursing work and develop 
its highest possibilities along civic lines. Several 
nurses must be mentioned whose too early death cut 
short careers which had already been distinctive in 
social service of rare quality: these were Mary E. 
Smith, of the Farrand training school in Detroit; 
Elizabeth Parry Upjohn, trained at St. Luke's, 
Utica; Ellen Wood, of the Johns Hopkins, who 
worked in her native State, New York, and Lucy 
Fisher, in California. 

The campaign against infant mortality is enrolling 
nurses in groups and as individuals; the Committee 
on the Prevention of Blindness appointed a nurse 
w r ho proved a most able secretary, Miss Carolyn Van 
Blarcom; in the long-neglected domain of the mid- 
wife and her work, nurses have made the most fruitful 
investigations, notably that carried through by Miss 
Elizabeth Crowell, trained at St. Joseph's, Chicago, 
in New York City, for the Union Settlement and 
Neighbourhood Association. 1 Miss Crowell was 
selected by Miss Wald for this piece of work, and 

1 "The Midwives of New York," by Elizabeth Crowell, in Chari* 
ties, Jan., 1907. 



228 A History of Nursing 

from it have grown the regulations of the Health 
Department relating to midwives and the municipal 
training school for them. 

Almshouse nursing reform was successfully 
founded in Michigan in 1906. Under the leadership 
of Caroline Bartlett Crane, the well-known civic 
reformer, the nurses' state society, in co-operation 
with the women's clubs of the state, carried on a 
systematic inquiry into almshouse conditions. Mrs. 
Crane's fearless exposures gave electric power to the 
advance of the women, and nurses were placed in two 
almshouses. A report 1 of this invasion made in 1907 
was the starting-point for the formation of special 
"Almshouse Committees" in almost every state 
association of nurses. These committees are ready 
to ally themselves with women's clubs, and some 
have already accomplished definite things in aims- 
house reform. Even more than other institutions, 
however, almshouses are in the grasp of petty and 
venal politicians. Until women attain full citizen- 
ship no thorough-going improvement can be made in 
them. 

Instances of affiliation between women's clubs and 
nurses' societies, in the interest of social reforms, are 
numerous, and in many cases the state federations 
and associations are united. 

With the growth of visiting nursing, calls came fast 
for nurses to take positions in mills, factories, and 
department stores to guard the health of employees 
and keep rather than make them well. 

Hospital social service was first placed upon the 
basis of a distinct specialty at the Massachusetts 

*A. J. N., August, 1907. 



The United States 229 

General, though there has probably never been a 
hospital where personal " follow-up " work has not 
been done at some time by superintendent, or nurse, 
or physician. For years members of the superin- 
tendents' society have emphasised the human values 
in visiting nursing as an extension to the hospital 
service, and, in 1904, a most useful and practical de- 
partment of this kind was inaugurated, through the 
efforts of Miss Maxwell, at the Presbyterian in New 
York. Here, from the first, social service was made 
a part of the nurse's work. In Boston, Miss Isabel 
Garnet Pelton, a nurse, and Dr. Richard Cabot 
together began and developed the well-known de- 
partment with which Dr. Cabot's name is especially 
linked. Miss Pelton, a woman of delicate insight 
and rich compassion, had already felt keenly all the 
unfulfilled needs of the discharged patient. Dr. 
Cabot had long desired some bridge between the 
physician and 'the domestic and social conditions 
bearing on the diagnosis and treatment of cases." 
In 1905 they began experimentally the department 
which now employs a large staff of specialised assist- 
ants. Dr. Cabot stood back of the work financially 
until it had become thoroughly established and sup- 
ported by voluntary contributions. When Miss 
Pelton's health failed, she was succeeded by Miss 
Ida Cannon. 

Belle vue followed the example in 1906. The sug- 
gestion that a social service department be opened 
there first came from Mrs. John Wilkie, one of the 
board of managers of the training school. She had 
consulted Miss Wald, who encouraged the idea, and 
suggested Miss Mary A. Wadleigh as the nurse best 



230 A History of Nursing 

fitted to carry it out. The plan was approved and 
set in motion by Dr. Armstrong, then medical super- 
intendent of the hospital, with the greatest goodwill. 
The Bellevue social service department rapidly 
became one of the most highly developed and exten- 
sive in its scope in the country. In September, 
1911, Miss Pelton, writing to The Survey (vol. xxvi., 
No. 24, p. 843), reported forty- three hospitals develop- 
ing social service, and many more planning to do so. 
Swiftly following on came indications that there 
might soon be calls for the nurse to teach practical 
hygiene in the public schools, and this the more ur- 
gently as the crusade against venereal disease began 
to raise its banners here and there. In Cleveland, 
Mrs. Robb gave a series of health talks to pupils 
and teachers in the public schools, and was shocked 
to find how vast was both their uninformedness and 
their indifference. She urged nurses to prepare to 
teach the hygiene of sex. In the Charleston schools, 
Mrs. Lounsbery did the same thing. In Pittsburg, 
the nurses carried the teaching on tuberculosis pre- 
vention to the children in the public schools. In the 
far western states, some of the first definite teaching 
in the schools on sex hygiene was initiated by nurses. 
The nursing profession as an organised body took 
up seriously the campaign against venereal disease 
in 1909, and began its own education on this sub- 
ject, including the history and social aspects of the 
evil; for, in a rude awakening, it was realised that 
hospital directors and medical staffs were leaving 
this whole vital question almost entirely in oblivion, 
so much so that the pupils of training schools, going 
out presently as professional women, were almost as 



The United States 231 

ignorant as schoolgirls of the history, extent, dangers, 
and social basis of the diseases called the black plague. 
[Not only in the United States, but internationally, 
nurses are joining in the attack on the social evil.] 

The rapidly rising tide of the demands for nurses 
to take new lines of work has swept far over the line 
of their ability to meet it. From all parts of the 
country are coming veritable clamours for nurses 
possessing social tact, sociological knowledge, power 
of initiative, and executive gifts. The trend of the 
need is indicated in the oft-recurring words : " A nurse 
is needed who is not only a nurse," and again by these : 
"A nurse is needed who can tell us how to develop 
our work; we do not know ourselves just what to do." 
In a word, the new demand is for nurses who are also 
teachers and organisers, or upbuilders, of actively 
wholesome conditions of living. Does this mean 
that now, at last, the nurse is to cut loose from medical 
direction? In medical questions, in the care of the 
patient, not in the very least. This is a bugaboo 
which is continually being banished and as continu- 
ally reappearing. The well-taught nurse cherishes 
her professional relation to the physician. But in 
infinite matters of social adjustment she must, in the 
best interests of the public, be free, just as he is free, 
and as all social workers must be. 

For a number of years the nursing profession at 
large had been coming to feel more and more clearly 
the need of special training to fit its members for the 
new demands. * The question of how and where to 

1 In 1906, the Instructive Visiting Nurse Association in Boston 
opened a training school for district nurses with a four months' 
course. 



232 A History of Nursing 

obtain such equipment became an urgent one in 
national conventions. Leading women, such as those 
in settlements and at heads of hospitals, were em- 
barrassed by the many demands which they could 
not fill. How this call was finally met has been told 
in the pages upon educational progress, but it is 
not yet satisfied. It will require literally hundreds 
of women, of culture, imagination, and the highest 
professional skill, to satisfy it. 

The changing status of the nurse is indicated by 
the growing tendency to make her an employee of 
the city and the state. The most striking ex- 
amples of this are found in the public school work, 
and in the anti-tuberculosis campaign. Pennsyl- 
vania has its entire territory covered by a har- 
monious system of dispensary stations and sanitaria 
for tuberculous patients, and the large staff of 
nurses employed by the State Health Department, 
with a chief nurse in her office in the Capitol, visit 
over the whole Commonwealth. If epidemics of 
other disease, as typhoid, threaten, some of them 
are at once detailed to duty on the spot. In 
this direction the nurse has, at present, outrun 
the physician, but in the socialising process it is 
certain that both will take even larger places as 
public servants. American Medicine recognises 
this, in commenting on serious foreign discussion of 
plans for making all medical men public officials on 
salary. It says: "Socialism's demand for free med- 
ical care is a phenomenon bound to exert a profound 
change in the destiny of the medical profession," 
and condemns the present demand that doctors shall 
donate their services to the poor as "most unjust. 



j i 



The United States 233 

It is coming to be seen that to throw the burden of 
charity on the shoulders of a few overworked private 
individuals is not only unjust, but unintelligent, 
and that society, as a whole, must finally assume its 
responsibilities to all its members. The true solution 
of the nursing of patients of moderate means, so often 
discussed by nurses and physicians, must be looked 
for in this gradual extension of service under the 
direction of the community as a whole. It cannot be 
effectually attained by the charity of private persons, 
the generosity of individual physicians, or the under- 
paying of nurses. But it can be done co-operatively, 
and there is every reason to hope that, in the future, 
armies of State-paid and State-pensioned physicians 
and nurses will replace our outworn armies of war as 
soldiers of health and defenders of public well-being. 
Indicative of the possibilities of co-operation is a 
recent report (1910) of the Cleveland Visiting Nurse 
Association, showing that, of fifty-seven nurses at 
work 

twenty-four are in the employ of the city, and twenty- 
two serve private organisations and institutions. All 
of these nurses have been engaged through the office of 
the Visiting Nurse Association, which makes itself 
responsible for their previous training, gives them, 
whenever possible, general district work, and tries to 
furnish each organisation with the nurses best fitted for 
its peculiar needs. The nurses in the employ of outside 
bodies are responsible to their own medical directors, 
but they all wear one uniform, they all meet once a week 
to discuss their problems, and as nurses they preserve 
a unity of ideals in their work. The nine district nurses 
who are salaried directly from the treasury of the Visit- 
ing Nurse Association take care of the sick poor under 



234 A History of Nursing 

the direction of district and private physicians. When 
none is present, they insist that one be called, because 
their relation to the doctor in the homes of the sick poor 
is the same as it would be in the homes of the well-to-do. 
... In Cleveland, the social dispensaries were the first 
to employ nurses who had had district training, and now 
hospitals, factories, boards of health and education, day 
camps, day nurseries, all have visiting nurse service. 
... In almost every case the Visiting Nurse Association 
has paid from its treasury the salary or salaries of visit- 
ing nurses for outside organisations, until the need of 
trained work in the home has been so well demonstrated 
that the other bodies have been more than willing to 
carry the expense themselves. . . . 

The rapid growth of visiting nursing in this country 
may be realised by reading the first and the latest 
special studies of this subject, both written by nurses. x 

That visiting nurses often become radical in their 
convictions is only a natural result of what they see 
in their work. Some such women have entered the 
Socialist party to work for a new social order. Others 
have thrown themselves into the movement for 
women's enfranchisement. The discontent they feel 
has been expressed by Miss Mary E. Lent, super- 
intendent of the Baltimore Visiting Nurses, in a 
paper read at Minneapolis, in the following words: 

When district work was begun in this country thirty- 
odd years ago, it was solely for the purpose of giving 
nursing care to the sick poor. The nurse brought relief 

1 The History of Visiting Nursing in the United States, by 
Harriet Fulmer, superintendent of the Chicago Visiting Nurse Asso- 
ciation, A . J. N., March, 1902, p. 41 1. Visiting Nursing in the United 
States, Yssabella G. Waters, member of the Nurses' Settlement, 
New York, Russell Sage Foundation, 1910. 



The United States 235 

to sufferers under intolerable living conditions, and it 
took great tact and ingenuity to obtain results under the 
circumstances. . . . The second stage in district work 
then came, and we worked for and talked about pre- 
vention. The nurse was the great educator and pro- 
tecting agent. We pictured her able to hold back 
vast epidemics of typhoid, to save the lives of thou- 
sands of babies; she taught the value of baths, fresh 
air, nourishing food and was dispenser of moral and 
uplifting ideas in general, all under these same in- 
tolerable living conditions, but tending in some vague 
way to improve them. 

-- We have now arrived at the third stage some of us, 
at least those who have been in the work longest and 
are willing to face the truth. At best, we are but Red 
Cross nurses on the field of battle. As such, there is no 
doubt that we are extremely useful, but in ourselves we 
do not stop the battle. For years we have been giving 
temporary relief in the way of skilled nursing care, 
under conditions that deprive it of three quarters of its 
value.1 We have also been trying to teach underpaid, 
overworked, underfed, wretched human beings how 
to live more hygienic lives. But the awakening has 
come at last. Our eyes are now open to the facts. We 
can no longer continue to dole ouT"surface relief, and 
believe that it stands for anything more radical. While 
we have been nursing the poor, while we have in some 
measure been able to investigate their condition, the con- 
ditions beyond our control have grown worse and worse. 
The number of new nursing associations is a direct re- 
sponse to the increasing hardships of living conditions 
the district nurse and the charity organisation are the 
philanthropist's recognition of them. ... It is for i's, 
who are palliative agents, to declare that the conditions 
of to-day do not call for palliative treatment. 1 
'See A. J. N., Aug. 1910, p. 867. 



236 A History of Nursing 

Whatever direction the future of nursing may take, 
it is certain that never before has it held such op- 
portunities for women of a noble stamp, broadly 
educated and alive to civic duties. And such women 
are coming forward, young and vigorous, overflowing 
with energy, in every state of our broad land. 

We could wish no better ending to our chapter 
than the suggestion given by the following letter 
from the secretary of our foremost medical associa- 
tion to a nurse member of her state examining board. 
May we not believe that it sounds the keynote of 
the future? 

The American Medical Association, through its Hos- 
pital Section, has undertaken the task of standardising 
and classifying the hospitals of the country with a view 
to their ultimate improvement in step with scientific 
medical progress. Such work must of necessity include 
a consideration of the nursing branches of hospital 
service, and I am writing to ask your cooperation and 
advice. The Hospital Section is starting out with a 
very definite determination to accept the trained nurse 
as a member of a learned profession, and contradistinct 
from a labour union, and its work will be to help elevate 
the nursing profession in ideals, and its members in 
efficiency to perform the duties of their high calling in 
consonance with the best thought of our time. Will 
you help us do that? I am just now needing badly a 
copy of your state law and your commission's interpreta- 
tion of that law in detail as to length of course in train- 
ing schools, subject matter of studies, and curriculum. 
May I hope that you will send me these, and in addition 
give me your views on the present trend of the profes- 
sion, the correctness of that trend, and your prediction 
as to the future of the profession. Signed - 



CHAPTER III 

NURSING IN THE COUNTRIES OF NORTHERN EUROPE 

Collaborators: A COMMITTEE OF SWEDISH NURSES; THE 

DANISH NURSES' ASSOCIATION; MME. SOPHIE 

MANNERHEIM, FINLAND 

Sweden. In Sweden, as in other countries, nursing 
the sick under various systems has been general since 
the beginning of Christianity. The religious orders 
in the Roman Catholic Church chiefly undertook the 
care of the sick and the poor, but on the decline of 
that church in our country, sick-nursing was either 
neglected or undertaken by people who lacked both 
the spiritual and practical qualities necessary for the 
nurse's calling. It was not until the middle of the 
nineteenth century that a revival of nursing was 
brought about. 

The first impulse to a new era emanated from the 
Deaconess Institution at Kaiserswerth, after which 
model the Swedish Deaconess Institution was 
founded. 

Florence Nightingale's great work among the 
wounded during the Crimean war, and the subsequent 
work she carried on in England, made her influence 
felt in Sweden as elsewhere. 

237 



238 A History of Nursing 

Interest in the training of nurses and in their work 
was also awakened by a number of articles in the 
Tidskri/t for Hemmet (Home Magazine}, and the 
establishment of a systematic course of nursing for 
educated women was seen to be highly desirable. 
An attempt to realise this scheme was made by 
the Red Cross Society in arranging a six months* 
course in nursing under the direction of a Matron 
trained at St. Thomas's in London. However, a 
sufficient number of specially trained nurses was 
not forthcoming. The Queen Dowager, at that time 
Queen Sophia, who always took a great interest in 
work among the sick, perceived how important it 
was that educated women should devote themselves 
to sick-nursing, and founded for this purpose the 
Sophia Home, which has now attained a remarkable 
efficiency and is the principal training home for 
nurses in Sweden. 

During the last quarter of a century the work of 
raising the standard of nursing has made great 
progress. From being an obscure and unimportant 
occupation, nursing is now considered to be a sphere 
in which educated women, if in other ways fitted for 
their task, find the best opportunities for the employ- 
ment of both their physical and mental capabili- 
ties. The following is a short review of the principal 
work which has been done in our country in this 
direction. 

The Institution of Deaconesses in Stockholm was 
founded in the year 1851, when a few sympathisers 
collected a sum of money and rented a small house 
in which they established a nursing home. Here 
the first pupils were received and trained, the Matron 







Deaconess Hospital Sisters, Stockholm 




Northern Europe 239 

at that time being Miss Marie Cederskiold, who 
had previously been sent to Kaiserswerth to study 
there. Her gifts for organising and teaching 
made her very valuable, but her health failed, 
and in 1862 she was obliged to withdraw from 
the work. She died in 1892. Very soon a school 
was established for children who had been treated 
in the nursing home or were there as convalescents. 
From this school grew the Children's Home, which, 
beginning with five inmates, was able after a 
few years to take in no less than forty. The 
number of Sisters desirous of becoming deaconesses, 
and suitable for the calling, was, for many reasons, 
during the institution's first years, inconsiderable. 
The vocation was as yet but little known, and many 
candidates were unsuitable, besides which the strict 
rules and somewhat unattractive uniform of the 
institution deterred many young women from apply- 
ing for admission. However, the work progressed, 
and in the year 1857, occupied new and considerably 
larger premises. The constant increase of the work 
led to the appointment of a clerical director, the first 
occupant of this position being Doctor Johan Bring, 
whose thirty-six years' work there was of the 
greatest importance to the institution. 

In 1864, it was moved to its present quarters, 
perhaps the most beautifully situated of any similar 
institute. Quite a little town has arisen around the 
chapel and is to be seen from an extensive radius, 
comprising a deaconess house, a house-keeping 
school, a chaplain's house, a home of protection for 
young women, homes for the aged, for children, 
and for incurables, also a hostel, and a fully- 



240 A History of Nursing 

equipped modern hospital, built in 1906. In 1909, 
there were 296 deaconesses attached to the institu- 
tion. Their training takes about four years, and 
includes a course of cooking and sewing, from a year 
to eighteen months' practical training in the sick 
wards, and other useful work connected with different 
branches of the institution. Every deaconess wears 
a uniform. The only requirements necessary for 
admission are: to be willing, for the Lord's sake, to 
tend the poor and sick; to profess the Protestant 
faith; to produce a doctor's certificate of sound 
health, and to be between the ages of twenty and 
forty years. One year's training is given to paying 
pupils, who, presumably, wish to undertake nursing 
work in their homes or for philanthropy's sake. 
Such pupils work in the hospital division and are 
theoretically instructed. 

The Swedish Red Cross Society. As far back as 
1 864, Sweden joined the Red Cross Convention which 
was founded in that year in Geneva. The Duke 
of Ostergotland of that time, afterwards Oscar II., 
became the first president of the society. Prince 
Carl, Duke of Westergotland, held that position 
when these words were written. Sweden was frjrtu- 
nate enough to have a nurse trained in the Nightin- 
gale school to organise nursing under the Red Cross. 
When the society was first founded, four months' 
training was thought to be enough, but in a short 
time the need of thoroughly taught, cultivated, cap- 
able women was felt, and Miss Nightingale was 
appealed to. Through her it was arranged for a 
Swedish lady to be entered at St. Thomas's, and 
Miss Emmy Rappe was chosen and sent, returning 



Northern Europe 241 

to take up the Red Cross work. In 1866, she became 
Matron of the New Hospital in Upsala, where she 
remained until 1877. She continued in hospital work 
until 1886, and died ten years later, revered and 
esteemed by the Society of the Red Cross for her 
path-breaking work and great services in teaching. 
The link which brought Miss Rappe forward we 
shall meet when we come to the Fredrika Bremer 
Society. 

As years went on the work developed more and 
more, until, in 1901, a house was purchased by the 
society. In connection with the home a nursing 
department was established. Pupils are received 
twice a year, fifteen or eighteen in each group. The 
course of training lasts for two years, and is divided 
into four periods of six months each, comprising 
theory and practice. For the former, physicians 
lecture on anatomy, physiology, and hygiene, and 
there is instruction in the elements of nursing. For 
practical work the pupils are passed through a series 
of hospitals so that they finally receive every branch 
of training, including maternity work and the care 
of sick children, the nursing of contagious diseases, 
and the care ,of the insane. During the latter part 
of their course they act as staff nurses in the home of 
the society. 

The pupils are required to possess a superior 
education, excellent physique, and sympathetic 
nature. The entrance age is between twenty-one 
and thirty years. When the training is ended, all 
nurses are required to spend one and a half years in 
private duty. They must also bind themselves to 
take up their duties for any requisite period, in the 

VOL. III. l6 



242 A History of Nursing 

event of the nation being involved in or threatened 
with war. 

Besides training nurses, the Red Cross Nurses' 
Home undertakes to engage other nurses who have 
gone through a complete theoretical and practical 
training course of at least one year, with six months' 
service afterwards at a larger hospital. Of the 
hundreds of Red Cross nurses, the greater number 
are always ready for mobilisation. 

A number are engaged at various regimental 
hospitals during field manoeuvres, in order to assist 
the physicians in their medical attendance and 
in any instruction in nursing given to the soldiers. 
The society has a benevolent fund for its nurses. 

The Sophia Home. It has been stated that the 
idea of a more general and effective reorganisation of 
nursing in Sweden arose about 1880 on the initiative 

^^% 

of Queen Sophia. Her Majesty had long cherished 
a desire to provide regular instruction in nursing 
based on Christian principles, for educated women, 
in which training special care should be taken that 
the work be carried out in a personal, and not merely 
in a professional, way. 

In 1884 a small home was opened in Stockholm 
with four pupils, a number which steadily increased 
as time went on. The direction of their instruction 
was intrusted to Froken Alfhild Ehrenborg, who had 
recently returned home after having studied at St. 
Thomas's in London, and having also spent some 
time nursing elsewhere in England. The pupils re- 
ceived their practical training at the hospital in Sab- 
batsberg. A small nursing department w r as arranged 
in connection with the home. The management of 




A Cooking Lesson in the Sophiahemmet 




Country Nursing in Sweden 



Northern Europe 243 

this was carried out on almost new lines, and won 
much approbation. This fact, and the need of an 
institution for training nurses on a larger and more 
independent scale, brought about the foundation by 
the King and Queen, in 1889, of a hospital called 
Sophiahemmet (The Sophia Home). This beauti- 
fully situated hospital has a nurses' home attach- 
ed to it, which was founded entirely by voluntary 
contributions. Her Majesty the Dowager Queen 
has from the very beginning been the president of 
the board of direction, and Her Majesty Queen 
Victoria of Sweden was the first honorary member. 
The board consists of twelve members, two of whom 
must be physicians, and three ladies. The plan of 
work is still carried out according to the principles 
established by the founders, which are, briefly, that 
however needful a thorough training may be in the 
theory and practice of nursing, it must not exclude 
the claim for a liberal education of the nurse and the 
development of her personal character. 

There is a Matron in charge of the home, but Miss 
Ehrenborg married after four years' pioneering. The 
pupils who desire to be admitted are required to be 
between twenty-one and thirty-five years of age, to 
profess the Protestant religion, to possess superior 
educational and physical qualifications, and, above 
all, to be serious and conscientious in their work. 
About twenty-five pupils are admitted every year. 
The training is partly theoretical and partly practical, 
each course being taken separately. After a six 
weeks' probationary period, a preliminary course 
begins, also lasting for six weeks. This includes 
lectures by physicians on anatomy, physiology, and 



244 A History of Nursing 

hygiene, with instruction in elementary nursing, in 
preparing food for the sick, and in gymnastics. In 
addition to these there is a Bible class conducted by 
the chaplain of the home. After one year's practical 
training, a month's theoretical course is given, com- 
prising lessons in medicine, surgery, etc., and, at the 
end of this, all pupils are examined in the various 
subjects they have studied. 

The practical training is given partly at the Sophia 
Home, and partly at the Serafimer, one of the princi- 
pal and most up-to-date hospitals in Sweden, of 
which the head surgeon and director, Professor John 
Berg, is a member of the board of the Sophia Home. 
The pupils also go through maternity, children's, 
and fever hospitals, and if they wish they may also 
take a course of work in the asylums for the insane. 
The whole training lasts three years, with a salary 
during the third year. Upon satisfactory completion 
of this course, the pupil is qualified as a nurse and may 
enter the sisterhood of the Sophia Home, and remain 
attached to it as long as she wishes to do so. If she 
leaves she devotes herself to some other work, or 
to nursing in other institutions. Opportunity is 
also given to pupils to go through a year's training 
on payment of a monthly fee, and a great number 
of women from Finland, Norway, and Denmark 
have taken advantage of this. 

It is the duty of all Sophia Sisters to go to whatever 
post the Matron may choose to send them. They 
receive their salary from the institution, have a 
pension fund of their own, and a Home of Rest for 
those who are ill and overworked, as well as a home 
for the aged. All Sophia Sisters wear uniform, a 











In the Sophiahemmet 




Northern Europe 245 

nurse's badge in the shape of a brooch, and an arm- 
band which each one receives on joining the sister- 
hood. Since the foundation of the Sophia Home, 
435 y un women have gone through either the 
short or the complete courses of training. Many 
have registered as members of the Red Cross or the 
Fredrika Bremer associations, or have taken up 
social or mission work. Teaching Sisters who have 
been especially valuable in perfecting standards are 
Sister Sally Petersen, Sister Valborg Nordin, and 
Sister Elise Linder. 

The Samaritan Home in Upsala was founded by 
Froken Ebba Bostrom, who, after a visit to England 
in the years 1878-79, when she stayed at the Penne- 
father Institutes at Mildmay in London, started a 
home for fallen women in Upsala. From this begin- 
ning a complete institute gradually developed, with a 
servants' home, a children's home, a hospital, etc. 
Then the whole was handed over to the Samaritan 
Institution for training deaconesses and parish 
Sisters. The training of deaconesses there is based 
on the same principles as the Deaconess Institute in 
Stockholm, with but a few slight differences. It 
takes from three to four years, of which from eighteen 
months to two years are spent in a course of sick- 
nursing. 

Parish Sisters are trained here chiefly in order to be 
able to tend the sick and poor in the country dis- 
tricts. Their course only takes eighteen months, 
and their training is somewhat similar to that of the 
deaconesses, though simpler and shorter. The pupils 
have to study practical nursing for a period of ten 
to twelve months, the rest of the time being occupied 



246 A History of Nursing 

by a theoretical course, the nursing of children, and 
practical parish work among the sick and the poor 
in the town, under the direction of experienced 
deaconesses. Throughout the training more stress 
is laid on the Christian side of the work and the 
development of the nurse's character than on mere 
technical ability, though this is by no means neg- 
lected, and the institution does all in its power to 
make its nurses thoroughly efficient. 

The South of Sweden Nursing Home was founded 
in 1901 for the purpose of training nurses for hospitals 
and private work in southern Sweden. The home, 
which is situated in Lund, offers a residence for pupils 
during the period of training, and has a registry office 
in connection with it. In this office are received 
highly recommended nurses who have gone through 
a theoretical and practical course at other institu- 
tions. The course at this home is of two years' 
duration, partly at the large hospital in Lund, partly 
at that in Malmo, as well as at fever and maternity 
hospitals, and lunatic asylums. The pupil binds 
herself to remain in the service of the home for one 
year after her training is complete. Here, too, the 
requisite qualifications for admission are good health 
and ample education. 

At Sabbat sberg, one of the largest hospitals in 
Stockholm, with about seven hundred beds, a two 
years* course of theoretical and practical training is 
given. At the Sahlgren, the general hospital of the 
city of Gothenburg, with about three hundred and 
fifty beds, a similar course is arranged comprising 
eighteen months' training. Shorter training courses 
for nurses are, moreover, arranged at the Academy 



Northern Europe 247 

hospital in Upsala, and at most of the district hospi- 
tals, the latter principally intended for training dis- 
trict nurses. There are such nurses in many country 
parishes, and their salary is paid locally. At the 
asylums for the insane at Stockholm, special six 
months' courses are arranged for nurses who have 
previously gone through a complete course at a 
larger hospital. 

The general hospitals in the towns, and the district 
hospitals, are supported by the state, the towns, or 
the parishes. 

The Deacon Institute at Skondal, near Stockholm, 
was founded in 1898 on the same principles as the 
Deaconess Institute. Men are trained to work as 
parish deacons, managers of lunatic asylum depart- 
ments, poorhouses, homes for inebriates, etc. The 
number of deacons trained was, in 1909, about fifty. 

Connected with the Methodist Church there is a 
society for attending sick persons, called the Bethany 
Institute. This supplies nurses, principally for priv- 
ate nursing, trained at Bethania-Krankenhaus in 
Hamburg. The training is for eighteen months, 
starting with three months' probation. A good 
education is desirable, but not absolutely necessary. 

The Roman Catholic Elizabeth Sisters have worked 
at private nursing in Stockholm and Gothenburg 
since the year 1875. Their training lasts from two 
to three years and takes place at Breslau. They 
work without any regular fee. 

The Fredrika Bremer Association. Fredrika Bre- 
mer, the celebrated Swedish authoress (b. 1801 d. 
1865) who was a pioneer in so many ways, had a 
tender heart for all human suffering. She was 



248 A History of Nursing 

herself a tender and loving nurse to sick dependents 
at her home in the country, and in her writings she 
has shown how highly she valued the work of nurses, 
and how much she considered it to be the fitting 
work of an educated lady to help and tend the sick. 
Sophie Lejonhufvud-Adlersparre, who took up and 
carried out the ideas started by Fredrika Bremer in 
so many different directions, was also an ardent 
friend of nursing, and in the Home Magazine, 
(Tidskrifl for Hemmet), edited by her, a number of 
articles have appeared, all bearing testimony to her 
keen interest in nursing reforms. It was therefore 
with the greatest joy that she received, in the early 
sixties, an offer from Florence Nightingale to find a 
vacancy for a Swedish pupil at the then recently 
opened Nightingale school, and she immediately set 
about finding an educated young woman who would 
like to avail herself of such a good opportunity of 
being trained as a nurse. Thus, in 1866, through her 
mediation, Sweden obtained her first trained nurse 
in Emmy Rappe. 

When Sophie Adlersparre founded, in 1881, the 
Union that bears the name of Fredrika Bremer, it 
was quite natural that its work should embrace 
questions pertaining to nursing and nurses. The 
object of the Fredrika Bremer Association is to try 
and better the position of women in moral and 
intellectual, as well as social and economic, matters. 
With regard to the nurses, the association has tried 
to fulfil its purpose in the following way. From its 
funds, collected by means of contributions through- 
out our country, the association has supported young 
women desirous of being trained as nurses. Since 



Northern Europe 249 

1896, when the funds had increased sufficiently to 
enable stipends to be granted, about sixty such 
grants have been paid out for the training of nurses. 

At the registry office for educated women estab- 
lished at the founding of the association, nurses were 
also duly registered. At the request of physicians 
the registration of nurses was so enlarged as to be 
complete in itself. At a time when trained nurses 
were scarce, it seemed very difficult in case of sickness 
to get the necessary attendance, and the association 
filled a long-felt want by registering such nurses as 
were disengaged and sending them out to patients. 
In 1902 the association increased this department by 
moving it to a special office, where sick-calls could 
be received day and night. In 1907 the nurses' office 
founded in Gothenburg by the medical society of that 
town joined the association. Both these offices work 
under the same principles, being directed by Matrons 
who have been trained as nurses at the Sophia Home, 
and have belonged to this institute for many years. 
On certain days lectures for nurses are given at the 
offices, partly on professional, partly on other sub- 
jects. These offices are intended to be self-support- 
ing, and with the exception of some assistance given 
to them at first by private individuals, they have 
achieved their aim. The nurses of the association 
are allowed to join other societies, but, for practical 
reasons, they may not be registered at the same time 
at any other place. They wear a uniform with a 
badge on the arm bearing the initials of the Union, 
or the uniform of their training school. 

The sphere of action of the Fredrika Bremer 
Association being so extensive, the work is divided 



250 A History of Nursing 

and managed by different committees. As early as 
1893 a special board was formed "to watch carefully 
the development of practical nursing and, where 
possible, to apply the principles of the association.' 
This board takes the lead in all matters concerning 
questions of nursing or the interests of nurses with- 
in the association's sphere of work. The nine mem- 
bers of the board include three physicians and two 
nurses. 

Queen Sophia's Society for Maintaining Nursing 
in the Army and Navy was founded in 1900, and as 
its name shows, is intended to support field nursing. 
The society trains no nurses of its own, but its work- 
ing staff consists of deaconesses, Sophia Sisters, and 
district nurses (trained at district hospitals and 
allowed by the help of the Union to go through a six 
months' supplementary course at a larger training 
institute). The society has also formed nursing 
columns of members of the Y. M. C. A., and others 
in several of the larger towns, provided ambulance 
carts and sick- transport equipment, and arranged 
courses of practical training. On the initiative of 
Queen Sophia's Society, nurses were first engaged in 
1905 at encampments. 

There are in Stockholm four associations for nurs- 
ing in the homes of the poor ; the oldest was founded 
in 1888 by Mrs. Ebba Lind af Hageby (nee Hierta), 
who has given large donations to it. 

The general pension fund for Swedish nurses was 
founded in 1896, in order to provide pensions for 
nurses at the age of fifty (in exceptional cases fifty- 
five years), and after at least eight years' work. The 
lowest single payment must be 500 kroner, or at least 



Northern Europe 251 

25 kr. a year. A situation in the service of the state 
or of a parish entitles the nurses to a stipend from 
the state of not more than 25 kr. a year. The fund 
possessed, at the end of 1910, 1,115,000 kr., and had 
811 associates. In 1905 the Benevolent Society for 
Nurses was founded. It is open to all nurses who 
have gone through a complete training course, hav- 
ing for its object the giving of relief in case of short 
illnesses. 

In 1909, the Swedish nurses started a paper of their 
own, called The Swedish Nurses' Journal. It appears 
once a month and has been received with the greatest 
interest all over the country. It is edited and pub- 
lished entirely by nurses. Its beautifully artistic 
cover of white and blue gives the keynote to its fine, 
high tone and point of view in nursing matters. Its 
editor was Miss Estrid Rodhe, a strong, true, lofty 
character of most winning personality. She was 
deeply absorbed in all the work of organisation going 
on among nurses over the world, and was full of the 
joy of sharing in it to the full, when, in August, 1911, 
she was suddenly taken away by death, who came 
peacefully to her as a sleep. Her loss is a great one, 
and she will long be truly mourned by nurses at home 
and abroad. 

A periodical for voluntary nurses in time of war 
has also been started by a military doctor ; it aims to 
spread among the public a greater interest in, and 
knowledge of, military nursing. 

The want of union between the nursing institutes 
of Sweden gradually made itself keenly felt among 
Swedish nurses as a disadvantageous condition, leav- 
ing them more or less separated from one another, 



252 A History of Nursing 

and by 1909 this feeling had grown so strong that the 
first steps had been taken toward bringing into one 
association the members of the various nursing 
institutions, as well as all nurses who had gone 
through a course of not less than eighteen months, 
and who had added to this at least eighteen months 
of practical work in hospital or in private duty. The 
leading motive of such an association would be to 
unite its members for mutual help and encourage- 
ment, yet without altering their position with regard 
to the training institutions to which they belonged. 
A committee was appointed to draft the outlines and 
rules of a central union, and its proposals were laid 
before the members of the various institutions, 
meeting with such general approval that, on March 
14, 1910, a National Council of Swedish Nurses 
was formed, in perfect harmony with the many 
different mother institutions, and with the most 
lively interest of the nurses to insure its success. 
The first president of the association was Miss Emmy 
Lindhagen, Sister in the Serafimer hospital, Stock- 
holm, an admirable leader and strong, well-balanced 
nature. 

Sweden carries on an active anti-tuberculosis cam- 
paign, which received special impetus from the action 
of King Oscar II., in devoting a large sum presented 
to him by the nation on his twenty-fifth anniversary, 
to the erection of three State Sanatoria. For the 
completion and maintenance of these public institu- 
tions the Swedish Parliament made liberal grants, 
and the earnest crusade thus inaugurated was rein- 
forced by the active assistance of the National 
Society for Combating Tuberculosis, formed in 1904. 



Northern Europe 253 

This society has won great popularity by the direct- 
ness and practical utility of its methods, and has been 
instrumental in causing ample numbers of sanatoria 
and special hospitals to be dotted over the land. 
Nurses are actively engaged in this crusade, helping 
with experimental work and with teaching and 
supervision. In one district in the northern part of 
Sweden, where tuberculosis is especially frequent, 
periodical examinations of the health of the entire 
population are made, and the homes are inspected by 
the doctor and nurse, who carry lessons on hygiene 
from house to house. The association concerns itself 
also with the special training of nurses ; gives several 
scholarships for those taking the sanatorium train- 
ing, and arranges dispensary courses for nurses 
who are to be appointed as assistants to the physi- 
cians in the many tuberculosis dispensaries over the 
country. 

One of the younger women whose influence in 
Swedish nursing is wide is Miss Therese Tamm, who 
led the delegation to the London Congress in 1909. 
Her father was a member of the Swedish Upper 
House of Parliament, and on his estates, twelve miles 
away from a doctor, she first felt the need of being 
useful in sickness, and, when only about twenty, took 
a short course at Sabbatsberg's General Hospital. 
Later on, so helpful had been the brief study 
that she entered again for the full training, and 
was certificated, intending to take up social work 
of some kind. But it was then necessary for her 
to become the daughter at home instead. Not 
allowing her interest to flag, Miss Tamm became a 
member of the Directors' Board of the Sophia Home, 



254 A History of Nursing 

of a Home for the Aged, another for epileptic and 
idiot children, and is also, while we write, a Guardian 
of the Poor in the parish where she lives, besides 
being in touch with the international organisation 
movement. 

Denmark: The Deaconess Institute. The honour 
of having first introduced an organised nursing sys- 
tem into Denmark is due to the Danish Deaconess 
Institute, which owes its founding to the Crown 
Princess Louise, consort of the Crown Prince Christ- 
ian, who during a visit to Mecklenburg had had 
occasion to see the great work which was carried 
on from the mother institute, Ludwigslust. Louise 
Martinie Laurette Conring became the first Sister 
Superior of the Danish Deaconess Institute. Dur- 
ing the first Danish-German war she came to 
Copenhagen, began early to work in the service of 
philanthropy, and in 1855 was Matron of the Royal 
Hospital. 

In i86~2 Princess Louise sent her to Stockholm 
that she might study the Swedish Deaconess Instit- 
ute, and she later visited different mother-houses in 
Germany and France. In 1863 the Danish Deacon- 
ess Institute was founded, and managed by her until 
her death in 1891. The start was very modest. A 
house on the outskirts of the town was rented, and a 
couple of the largest rooms were made into wards. 
The Sister Superior and two Sisters had their dwelling 
upstairs. The next year their numbers had risen to 
six. The small institute was soon heavily burdened. 
In 1864 Austria and Prussia waged war against 
Denmark. It was the first war where deaconesses 
shared in the nursing of the wounded. The army 



Northern Europe 255 

staff-surgeon at first had his misgivings in accepting 
their assistance, but after the war he expressed his 
most sincere praise of their work. It very soon 
became evident that the accommodation of the small 
house was inadequate, and a larger house was ac- 
quired in 1865. The number of Sisters had in- 
creased to seventeen. It thereby became possible 
to commence private home-nursing, at first in the 
capital, later on in the country. 

But much other work was carried on: the care of 
released female prisoners, of women addicted to 
drink, of servant-girls out of employment, children's 
instruction, and other useful service. The demand 
for a building of its own had grown stronger and 
stronger, and in 1877 the large group of buildings 
which is now the home of the institute was inaugur- 
ated. In 1888, the institute had six branches where 
the Sisters were at work under central supervision, 
and sixty-two stations where the work was carried 
on under the direct management of local boards, 
acting in harmony with the mother institute, 
which retained the final authority. The number 
of Sisters was then one hundred and fifty. After 
the death of Miss Conring, the position of Sister 
Superior fell to Miss Sophie Zahrtmann, and great 
progress was achieved under her supervision. One 
hundred Sisters were employed in 1907 in parish 
nursing. Others were working in infirmaries and 
in almshouses, children's homes, asylums, infants' 
asylums, convalescent homes, health resorts for 
female inebriates, a pleurisy sanatorium at Odense, 
in the island of Fiinen, and an educational home 
for epileptic girls on Zealand. It was not only 



256 A History of Nursing 

to the home country, but also to the remote pos- 
sessions of Denmark that the Deaconess Institute 
carried its work. The Sisters have started con- 
gregational nursing in Thorshavn in the Faroe 
Islands; a children's asylum was opened in 1906 in 
the Danish West Indies on the island of St. Croix; 
and the year after a similar asylum was started in 
the western part of that island. In 1907 the Sisters 
numbered 305, and yet the management has often 
wished for a greater increase. 

The St. Lucas Institute. Another deaconess in- 
stitute grew up later in Copenhagen. In 1886 Miss 
Isabella Brockenhuus Lawenhjelm began working 
amongst the poor of the north end of the capital. 
In 1893 she started a clinic which, through the dis- 
tinguished surgeon, Professor Kaarsberg, acquired 
such a patronage that, in 1901, it had fifty-six 
beds. At the same time she had working rooms for 
one hundred children. The house, which was later 
made into a hospital, now bears the name of the St. 
Lucas Institute. It had, in 1904, thirty novices who, 
after their apprenticeship, are consecrated as deacon- 
esses, and is an important and growing institution. 

Before the end of the nineteenth century nursing 
had progressed greatly in Denmark. In 1876 the 
humane and enlightened system of modern nursing 
after the British model had been introduced into 
the largest hospital of the capital, the Municipal, 
by Dr. C. E. Fenger, himself a physician, but one 
time minister of finance and later burgomaster of 
Copenhagen. 

The Red Cross. --In 1876 there was started in 
Copenhagen "The Society for Nursing the Sick and 



Northern Europe 257 

Wounded during Warfare,' which soon altered its 
name to 'The Red Cross/ adhering to the inter- 
national society of that name. His Majesty King 
Christian IX. graciously consented to be the society's 
patron, and as presidents there were, consecutively, 
the Generals Thomsen, Pfaff, Schroll, and Arendrup. 
The society had a branch at Aarhus in Jutland where 
several nurses were trained. As no regular nursing- 
school was available, the society made an arrange- 
ment with the Deaconess Institute and with several 
hospitals to train its pupils. The apprenticeship 
was to last for a year, spent alternately in a medical 
and a surgical division, as well as in a lying-in 
hospital. During the Greco-Turkish war a laby of 
Copenhagen defrayed the expenses of sending a 
physician and ten nurses to Athens, where they were 
employed after the battle of Domakos. The society 
has been of importance to nursing in general. Its 
nurses have been greatly in demand for private 
nursing as well as for different institutions. The 
position and training of its nurses were gradually 
considerably improved. They now get a three years' 
training and supplementary courses at the military 
hospital of Copenhagen. Their salaries have been 
increased, and they are provided for in their old age, 
partly through self -pensioning, and partly through 
help from the society. It is hoped in this way to 
get a largely increased nursing staff. A number of 
nurses for the country are trained in ten months' 
courses under the supervision of the society. In 
1900 the Women's Branch under the Red Cross was 
established with Her Majesty the Queen as patroness. 
In 1910 it had thirty -one subdivisions all over the 

VOL. III. 17 . 



258 A History of Nursing 

country, with 4371 members. The efforts of this 
branch have been directed especially toward collect- 
ing resources in case of war, and holding "Samaritan " 
courses (First Aid) for women and men. In 1909 
the Red Cross amended its laws, and for the first 
time a woman joined the board, on which, in 1911, 
two women held seats. In 1912 a nurse, Miss 
Cecilie Liitken, was on the board and was sent 
as delegate to the international conference. 

The demand for a better trained class of nurses 
had become ever greater, especially in Copenhagen. 
The parish nursing employed many, but their train- 
ing was frequently very deficient, as every pupil or 
charwoman from the hospital could, without being 
prevented, call herself a nurse. In the country 
the want of better conditions was also felt. There 
the pioneer reformer of early times was Dr. T. M. 
Trautner, in the small town of Bogense, island of 
Funen, who in 1881 became government physician 
for the island. He wrote a guide for hygiene and 
nursing for country folk, and founded local nursing 
societies all over the provinces, which gradually, 
partly with help from the government, attained 
great importance. The Central Society, organised 
in 1909, and of which Dr. Jacobi was chairman, 
did great work in the country by uniting the so- 
cieties, improving the conditions of the nurses, and 
giving the public a clear understanding of how 
valuable a well-trained corps of nurses is to the 
social order. 

The Danish Nurses 1 Union- -This association or 
union was organised in 1899 with the object of pro- 
moting the interests of the nurses, both profession- 



Northern Europe 259 

ally, and in material things as well. Every nurse 
between twenty-five and forty years of age, who has 
had a three years' apprenticeship in a hospital or 
infirmary, may be admitted as a regular member, 
while probationers may be admitted as associate 
members. Other persons are admitted as passive 
contributing members. 

In the early, unformed stage of the association its 
affairs were warmly taken to heart by Mrs. Charlotte 
Nome (nee Harbou), who, an ardent, life-long suffragist, 
noted the budding strength of the new profession in the 
light of the Woman's Movement, and felt also the sym- 
pathetic interest natural to a woman, who, the wife of a 
public medical officer, had in her younger days entered a 
hospital as an exploring volunteer, long before the days 
of secular training, and there spent several months pre- 
vious to her marriage. As a delegate to the London 
Congress of the International Council of Women in 1899, 
Mrs. Nome was present at the inception of the Inter- 
national Council of Nurses, an organisation which ap- 
pealed strongly to her and of which she became a charter 
member. She was the first chairman of the infant Union 
of Danish Nurses. As it gathered strength its members 
felt the need of a fully trained nurse to lead their steps, 
and chose Mrs. Henry Tscherning (nee Schultz), a woman 
of great ability and energy, who has continued as presi- 
dent of the association to the present day and has built 
it up in every direction with sagacity and single-hearted- 
ness, never giving way before difficulties, but with un- 
flagging zeal holding to her aims. 

Mrs. Tscherning had been trained in the medical 
divisions of the Municipal Hospital of Copenhagen 
in 1878. She was afterwards appointed lady super- 



260 A History of Nursing 

intendent there, and won deserved repute by extend- 
ing the nursing service into the surgical divisions. 
Realising the need of further study, she went in 
1883 to St. Thomas's, and, as a guest for a number 
of weeks in the Nightingale Home, familiarised her- 
self with its principles of management and became 
deeply convinced of the necessity of entrusting 
training and discipline to a trained, expert, and 
educated gentlewoman. 

An excellent help and support has Mrs. Tscher- 
ning found in the two ladies, Miss Bodil Hellfach 
and Miss Cecilie Lutken, who have taken their 
share of the work since the Union was started. 
Miss Hellfach came in 1887 to the Municipal 
as head of a division. For eight years she was 
vice-chairman of the Danish Nurses' Association, 
and then a member of the board of representatives. 
Miss Lutken worked for some years in hospitals 
abroad, but came in 1896 to the Municipal Hos- 
pital as assistant operating-room nurse, and then 
became chief nurse of the Military Hospital of Copen- 
hagen, besides being a member of the board of the 
Red Cross. For nearly ten years Miss Lutken was 
a member of the board and secretary of the Dan- 
ish Nurses' Association, and has in that capacity 
rendered it excellent service. 

The number of members of the association in- 
creased rapidly. The year after its organisation it 
counted 291 regular and 107 associate members. In 
1911, there were 1182 regular and 217 associate mem- 
bers. It has been agreed that all ordinary members 
when on duty shall wear a badge indicating their 
membership, and the Red Cross allows its members 




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Northern Europe 261 

also to wear this badge, though not in war time or 
abroad. One of the first enterprises of the association 
was to establish an office, wherefrom nurses could be 
sent out to nurse by the hour. They were to reside 
at the office, and such nurses should preferably be 
engaged as could not endure the exhausting night 
duty in hospitals and clinics. After some time the so- 
ciety also provided nurses for day and night. It was 
a great advantage to the nurses that the society, on 
the co-operative plan, only reserved to itself five per 
cent, of the fees, while private individual registries 
generally retained fifteen per cent. The office, where 
sixty members are now housed, has frequently been 
enlarged, and another has been established in Copen- 
hagen as well as in the provincial town of Aarhus in 
Jutland. Both are thriving well. There were fur- 
ther organised a sick club and a burial club for mem- 
bers. In 1901 an assistance fund was started, and, 
in 1903, a cooking-school. The next year there was 
founded at Vedbeak, near the Sound, a recreation 
home for vacations and rest. In 1902 the association 
secured for its uses a yearly subvention from the 
government, amounting to 4000 kr., which the fol- 
lowing year was increased to 6000 kr. Of this 
amount 4000 kr. are used for the further training of 
nurses, and the remainder for the offices. But the 
main object of the Union is to procure a better and 
more efficient training. Hitherto a one year's ap- 
prenticeship had been considered sufficient, and many 
had been content with ten months or even less. The 
association tried to help those who had received 
but a one-sided training, by supplementing this in 
the different hospitals with which it had made 



262 A History of Nursing 

agreements to have its members received. In January, 
1901, the Union founded its official journal, Tids- 
skrift for Sygepleje, which has been of the greatest 
usefulness in its upbuilding work. The first editor 
was Miss Elise Fiedler, a superintending Sister, who 
carried the journal through its first five years. Since 
that time it has been edited by Mrs. A. Claudius, 
who, before her marriage to a physician, was a nurse 
in the Kommunehospital. At first a monthly, the 
Tidsskrift is now issued bi-monthly. It is sent to 
every member of the association and has a large 
circulation, being highly esteemed for its excellent 
professional articles. 

The oldest of the regular hospitals in Copen- 
hagen was the Royal Friederic's, built in the 
middle of the eighteenth century and now quite 
antiquated. It was resolved to replace this one by a 
large modern hospital to be built on one of the Com- 
mons, where it would get sufficient light and air. 
The Nurses' Union frequently petitioned the Medical 
Council and the Ministry to grant that a modern 
nursing school should be made part of the hospital, 
where the pupils by rotation in service would get an 
all-round three years' training, and where all the 
nurses should be placed under the authority and 
direction of a trained woman head. 1 Even though 
the association has not yet seen all its demands com- 
plied with, still great improvements have taken place, 
and will finally lead, without a doubt, to a fully 
satisfactory traiirng of nurses. It is also to be hoped 
that the proposal for an act, whereby the nurses 

1 The Matron or head of the whole nursing department is non- 
existent in large Danish hospitals. 




Cecilie Liitken 
Red Cross Sister and Member of the Board of the Red Cross Society, DenmajpJr^Y, 




Northern Europe 263 

shall obtain governmental license and which has been 
submitted to the Ministry of Justice, will be carried 
in the near future. 

It has been the great aim of the Danish Nurses' 
Union to insure the nurses against an inadequate 
training, and out of chaotic conditions to establish 
regulated and legal conditions for a class which during 
the last thirty-odd years has grown to comprise three 
to four thousand members of the Danish population. 

Finland. Nursing in Finland has always been 
done chiefly by women. Except in the men's wards 
in asylums for the insane, syphilitic men's wards, 
and in our army, while it existed, we have never 
had any men-nurses. 

In olden times, before the day of hospitals, the 
so-called 'wise women" combined the functions of 
doctor and nurse. Their methods consisted chiefly 
of wet-cupping, hot vapour baths, and massage, and 
even nowadays there are people, mostly belonging to 
the peasant class, who have greater faith in the 
prescriptions of 'wise women' 5 and "wise men,' 
than in those of any medical man, and, as their 
methods largely appeal to nature's own curative 
power, the results they obtain are often very satis- 
factory. In the darkness of the Middle Ages, it was 
not always without danger to be a ''wise woman.' 
Many, especially if their cures had been successful, 
were tried for witchery by the Church, which con- 
sidered the nursing of the sick one of its prerogatives. 

The first hospitals in Finland were, of course, 
founded by the Church. The hospital St. Goran, 
(St. George) built in 1355, was a "leprosarium," and 



264 A History of Nursing 

that of the Holy-Spirit, built in 1396, was, like several 
of the same name in Sweden, an infirmary for "the 
sick and poor." Both of these hospitals were situated 
in Abo, the oldest town in Finland, and the first 
centre of the Swedish civilising influence. It was 
not until 1475 that another hospital was built in 
Finland in the town of Wiborg, then the Swedish 
bulwark against Russia. This hospital was also a 
leper house and was situated a little outside the town. 
The order of St. Dominicus (the " black brethren") 
ruled over these first hospitals. At the head of each 
ft T as a priest-superintendent, and in connection with 
the hospital there was always a chapel, divine service 
occupying, of course, much more time than nursing 
proper. Still it was the members of this and of other 
monastic orders which later on founded communities 
in Finland, who were then the only people who knew 
anything of disease and the curative properties of 
plants and herbs. A copy of an old book, which at 
the end of the fifteenth century was in use in the 
monastery of Nadendal tells the manifold properties 
of eight herbs: thus, 'juniperus, mirra, sinap, cas- 
toreum, malyrt, urtica, and mirtus," and one can 
easily imagine the brave little nuns receiving the sick 
and wounded and treating them after the prescrip- 
tions of this precious book, which had come with the 
nuns to Nadendal (the Valley of Grace), from the 
mother convent Wadstena in Sweden, founded by 
the Swedish saint Birgitta, after whom the order was 
named the Birgittines. . 

With the Reformation many things were changed. 
The supremacy of the monastic orders was gone, 
though the clergy still had something to say about 



Northern Europe 265 

the management of the hospitals. In an old regula- 
tion of 1558 we see that the hospital of St. Goran 
was then directed by a superintendent or tutor who 
had under his orders a chaplain, a bell-ringer, a man 
servant, and a maid. The last was the nurse, properly 
speaking; at least she had to help the patients to 
make their beds. The regulations of this hospital, 
as of all others at that time, were most probably 
written by King Gustavus I. of Sweden, who must 
have been a wonderful man, judging by the organising 
capacity he showed in so many different matters. 
He even understood nursing in a way quite surprising 
for those times. In 1555 when, during the war with 
Russia, the Swedish troops in Wiborg were suffering 
terribly from typhus and dysentery, the King wrote 
to the commandant of the fortress telling him to 
procure some elderly women to nurse the soldiers, 
and he even went so far as to prescribe what they 
should do for the sick. Of course wet-cupping was 
the most prominent feature of the King's prescrip- 
tion, and one may hope that among those poor people 
there were some of iron constitution who may have 
survived. 

In the times following the Reformation, the hospi- 
tals, so flourishing under the monastic rule, led a 
rather miserable existence. They were always asking 
the government for subsidies and complaining that 
they did not get them. Those were times of bloody 
warfare, and people had not time to think of the sick 
and suffering. In 1759 the first general hospital in 
Finland was founded in Abo by the Swedish govern- 
ment. This hospital, still existing as the Abo County 
hospital, was placed under the supervision of the 



266 A History of Nursing 

Serafimer Knights, as had been also the Serafimer 
lazaret in Stockholm, which had been founded a 
little earlier. This general hospital in Abo began 
with only six beds. It was entirely subsidised by the 
government, and to this day all county and general 
hospitals in Finland are government institutions. 
Those supported by towns and communities, as 
well as those small hospitals and nursing homes 
supported by private means, of which, besides the 
deaconess hospitals, there are a goodly number now 
existing in Finland, were all founded much later. 
That the nursing in the beginning of the last cen- 
tury was of the poorest description is plainly shown 
by the report written in 1809, shortly after the war, 
by a member of the Finnish Senate, 1 who, being 
sent on a tour of inspection to various institutions, 
thus describes an asylum he had visited : 

The inmates had scarcely any clothes (they had to 
wear their own). The windows, although in summer, 
were all shut, and the air was pestilential in the little 
dens, where not even straw was provided as bedding for 
the patients, who had to lie on the hard wooden boards. 
One man servant and one maid looked after forty- three 
patients under the supervision of a superintendent, who 
seemed to employ them more for his own gardening than 
for the needs of the poor patients, than whom no more 
miserable creatures could possibly exist. 

The maid or nurse was, according to the regula- 
tions, also the one who had to do all the washing and 
mending of the hospital. She had to sweep and 
dust and, if need be, wash the floors. Hers was the 

1 This senator was Mme. Mannerheim's great-grandfather. 



Northern Europe 267 

duty of making the beds for the weaker patients and 
of seeing that order and cleanliness reigned. The 
hospital regulations were framed by the government, 
and even if the bed making, considering existing con- 
ditions, could not have given her much trouble, still 
we, who know what her work means, do not wonder 
that the poor nurse was often unable to fulfil all of 
her manifold duties to perfection. 

As has been said, the nurses of these times were 
recruited from the servant class. Often enough such 
women grew to be very devoted attendants, but 
oftener, alas, their patients had to suffer terribly 
through the neglect and lack of efficiency of those 
under whose care they came. Generally the nurse 
of that day, here as everywhere, was an elderly 
woman, either married or a widow, often with a large 
family. Not longer ago than in 1893 the patients in 
one of the largest of Finland's county hospitals, that 
in Wiborg, were all nursed by women of that class, one 
of whom, a widow, had been born in the hospital, 
where her mother had been a nurse for forty years. 
She had succeeded her mother, had married and 
herself given birth to three children, while between 
times she nursed her patients to the best of her ability. 

Reform was badly needed, but it was not until 
after the middle of the last century that a lady, 
widely known in Finland for her philanthropic works, 
Mme. Aurore Karamzine, realised that something 
must be done, and did it. In 1867 she founded 
the House of Deaconesses in Helsingfors, and intro- 
duced a new system of nursing. The order of deacon- 
esses in Finland was a branch of the Kaiserswerth 
Association. Its first superintendent, Mrs. Amanda 



268 A History of Nursing 

Cajander, the widow of a doctor, had been trained 
in the Deaconess House in St. Petersburg, founded 
some years earlier. She was the first woman from 
the educated classes in this country to take up 
nursing and, as she was a very superior person, she 
succeeded, in spite of much opposition, in raising 
the standards of the nursing profession and making 
it respected. Her efforts were directed toward infus- 
ing into the work a spirit of devotion and self-forget- 
fulness, which we have ever since tried to retain. 
Her successor, who has carried on her w r ork in the 
same spirit and done much toward elevating the 
moral standards of nursing, was Miss Lina Snellman, 

'Sister Lina,' -who from 1883 has been the 
mother of the Deaconess House in Helsingfors up to 
the time at which this is written. 

The training given there lasts about two years 
and comprises practical work and teaching in the 
theory of nursing, anatomy, and physiology, to- 
gether with a short course in therapy. The nurses 
have had an important work to do among the suffer- 
ing poor, the efforts of the institution having always 
been directed toward training nurses for the very 
poorest people. Nearly all the district nursing ex- 
isting in Finland, in towns as well as in the country 
-as yet there is very little of it has been done by 
deaconesses. It is not more than justice to say that 
the work thus done has been beautiful work and 
that we nurses feel we owe the deaconesses a place 
of honour in the history of nursing, so far as it 
concerns Finland. 

When the Deaconess House started, a period of 
great suffering was just settling down over our 




Anna Broms 




Sister Lina 




Airs. Amanda Cajander 
"ork 




Northern Europe 269 

country. A famine year with its accompaniment 
of typhus and smallpox was reaping thousands of 
victims. The little hospital was crowded at once, 
and its staff of devoted young Sisters had an oppor- 
tunity of showing what they were worth. In com- 
parison with the nursing practised up to that time, 
the work done in this little hospital was a revelation, 
and achieved for the deaconesses a reputation for 
good nursing which they have kept ever since. The 
hospital began with only eight beds. In 1896 this 
number had risen to forty, and after the house was 
moved to its present site and rebuilt on a larger scale, 
the number of beds was more than doubled, so that 
it now counts one hundred, and the hospital was 
divided into three wards, a medical, a surgical, and a 
gynecological, a small surgical hospital for thirty- 
four children being added in 1906, to the building of 
which one of the present Sisters devoted a legacy left 
to her. In addition to this the house has founded a 
small sanatorium in the country for twenty tubercu- 
lous women. 

Besides the Sisterhouse in Helsingfors there are 
now three others in Finland: one in Wiborg, one 
in Uleaborg, and one in Sordavala. In the beginning 
of its existence that in Helsingfors was often required 
to send out nurses in private practice and as assist- 
ant Sisters to the secular hospitals, where, as has 
already been said, the standard of nursing was at 
that time very low indeed. 

The impulse to a better order of things in Finland 
was given by Dr. F. Saltzmann, the first surgeon 
attached to the House of Deaconesses, and after- 
wards head of the medical board, in which capacity 



270 A History of Nursing 

he did much towards raising nursing in this country 
to a higher level. He took the first step forward in 
1884 by starting a course of lectures on "First Aid to 
the Injured," which was attended by many young 
girls from the upper classes, for several of whom this 
meant the opening up of a new perspective and the 
awakening of an interest which sought to expand 
and to find a field of work. Dr. Saltzmann, always 
keenly aware of the need of educated women in the 
nursing profession, felt that a proper training must 
be provided for the girls who were eager to take up 
the work. The wished-for opportunity came at last 
when, in the autumn of 1888, the Surgical Hospital 
in Helsingfors was inaugurated. This hospital, one 
of the University group (the others are the Medical, 
the Children's, the Eye, the Skin, and the Gynecologi- 
cal hospitals), contained 152 beds. Dr. Saltzmann 
was its first prefect and, in the spring of 1889, started 
with six pupils the first course of training for nurses. 
Those were the first women of the educated class to 
be trained in Finland, and one of their number, Miss 
Fanny Tigerstedt, afterwards became Matron of the 
Medical Hospital, a post which she held at the time 
this was written. 

This first course of training was purely surgical. It 
lasted only six months, with teaching in the practice 
of nursing in the wards and lectures on the theory of 
nursing, given by the resident and the Matron of 
the Surgical Hospital. Dr. Saltzmann had suc- 
ceeded in getting for the new hospital a Matron of 
great intellect and capacity. She was an educated 
woman, or rather a girl, Miss Anna Broms, who was 
only twenty-five when she was given the post. She 



Northern Europe 271 

had received her training partly in Sweden, and 
partly at the Royal Infirmary in Edinburgh. It was 
she who, with the faithful assistance of Dr. Saltz- 
mann and of the resident, Baron Von Bonsdorff, 
organised the nurses' work in the hospital, which was 
no little thing to have done, and she gave herself 
heart and soul to the task of training women for the 
nursing profession. Her ow r n working life was not 
long the strain had been too much for her and she 
died in 1890 of heart failure. She was succeeded by 
Miss Hilda Montin, to whom the honour is due that 
in 1892 the course was lengthened to one year's dura- 
tion with work in the different hospitals. Seven 
months of that time were given to the surgical, 
operative, and outpatient work, three months to 
the medical, and one month each to the child- 
ren's, and eye, specialties. Miss Montin remained 
until 1903, when she was succeeded for a short period 
by Miss Olga Ohquist (Mrs. Olga Lackstrom, the 
present editor of Epione) and, on the marriage of 
the latter, by Mme. Sophie Mannerheim. As Mme. 
Mannerheim also received her training in England 
(St. Thomas's, London), two of the four Matrons 
of the Surgical Hospital have brought to the work 
English ideas and the English spirit. 

As years have gone by the interest in nursing has 
grown stronger and stronger in Finland, and at least 
half of the candidates who nowadays apply for train- 
ing in the University Clinics belong to the educated 
class. Since 1893 there have also been courses of 
training for another class of women held in several 
of the largest county and general hospitals. At first 
those courses were of half a year's duration, compris- 



272 A History of Nursing 

ing practical work in the wards and lectures by the 
Matron on the elements of nursing, but lately, in the 
hospital of Wiborg, a one-year curriculum has been 
established, and at the end of the course there is an 
examination. Those shorter courses have been insti- 
tuted to train nurses for the small country hospitals, 
and for district work in the country, and because, as 
yet, the need for nurses is so great that the supply 
from the hospitals of the university is by no means 
sufficient, these shorter courses of training have had 
a mission to fulfil, though it is to be hoped that before 
long only a few of the largest hospitals will retain the 
training of nurses in their hands, and that the Univer- 
sity Clinics will remain a kind of high school, where 
nurses can get special, as well as general, training. 
In a future which the early part of the century will 
see, they are all to be rebuilt on a site reserved for 
this purpose, and to that time nurses look forward 
for the introduction of a better training all over the 
country. 

One training course of two years had been de- 
veloped in the city hospital of Helsingfors, called 
the Maria, by Miss Koreneff, a graduate of the 
University Clinics, and, to the great satisfaction of 
Finnish nurses, early in 1912, she succeeded in her 
purpose of advancing this course to three years. 
The Maria is a small hospital, but its example 
in founding the first three years' training will be 
stimulating. 

The University Clinics, the largest training school 
in Finland, takes yearly forty-eight students in 
nursing, some of whom (about six per cent.), naturally 
drop out. However, about forty-five complete their 



Northern Europe 273 

training of one year's duration. To this year there 
was added, in 1905, a term of six months as staff 
nurse, either by night or day, in the wards, and on 
August 15, 1906, a preliminary training school was 
opened in connection with the hospitals. This train- 
ing school, as well as the earlier existing Probationers' 
Home, is maintained by the Association of Nurses 
in Finland, which receives subsidies from the govern- 
ment to enable it to carry on this work. 

To give in more detail the story of this home for proba- 
tioners, we shall go back to an account of it given at the 
Paris Conference by Mme. Mannerheim, for it is not only 
a fresh proof of the way in which Miss Nightingale's 
influence has been felt in every quarter of the globe, 
but it shows also a very attractive bit of local colour, 
the establishment of a probationers' home by an associa- 
tion of graduate nurses being quite unusual ; no other 
such piece of administration, we believe, has been under- 
taken by a society of nurses. 

"In 1888, when the new hospital was opened" [said 
Mme. Mannerheim], "and the one-year course de- 
cided on, the probationers had no central home ; they had 
to live in the town, and this was of course a great incon- 
venience. When the nurses' association was founded, the 
nurses decided to take the matter in their own hands by 
opening a home for probationers, for which the neces- 
sary funds were secured, partly from private friends, and 
partly from the Red Cross Society. However, the associa- 
tion could not compel the probationers to live in the 
home, and the hospital directors thought it an inter- 
ference with personal liberty to require it, so the home 
became a sort of hotel where the nurses could stay if 
they liked and as long as they wished. The results of 
this system were, obviously, a lack of discipline, and 

VOL. III. 18 



274 A History of Nursiug 

advantage often taken of the freedom accorded. The 
pupils who went to theatres or balls in the evening 
were not fit for their morning's work, and the others 
had to do double tasks. Then, as it was impossible to 
control the places where the nurses lived, cases of con- 
tagious disease not infrequently broke out in the hospi- 
tal, from infection brought by careless pupils. 

"It was at this juncture that one of our nurses, who had 
taken a course of training in England " [this was Mme. 
Mannerheim herself], "had the great privilege of meet- 
ing Miss Florence Nightingale, who, with the lively 
interest she always felt for everything connected with 
nursing, at once grasped the situation and told our nurse 
that we must make remaining in the home compulsory for 
the probationers. She was even kind enough to give a 
sum of money to be spent in the home 'so soon as it 
should contain all the probationers. ' This was brought 
about in 1906, and we are very proud of Miss Night- 
ingale's interest in our work, and feel it as a consecration 
and a stimulus to new efforts. 

' We have devoted her gift to a fund for a library, and 
the portrait of the donor, the mother of all nurses, smiles 
from the wall on her Finnish children. The house has 
now accommodation for forty-eight probationers, and the 
work of course goes much better since all are obliged to 
live together." 1 

The first and present superintendent of the 
preliminary school is Miss Ellen Nylander, who 
was trained at Tredegar House, London. The 
preliminary course lasts two months and comprises 
teaching in the practice and theory of nursing, band- 
aging, cooking, and the theory of foods, with the 
elements of massage, anatomy, physiology, and hy- 

1 Reports, International Conference of Nurses, Paris, 1907. 



Northern Europe 275 



giene. At the end of the course there are written 
and oral examinations, and the probationers who 
pass go over to the home and begin work in the 
wards of the different university hospitals. The 
home, which in the beginning was very small, was 
enlarged, in 1906, so as to accommodate all the proba- 
tioners in training. The course of training grew to 
comprise this preliminary course of six months, and 
one year's probationer work, during which time there 
were lectures given on therapeutics and surgical and 
medical nursing, with repetition classes. The staff 
nurses had yet no definite courses of lectures, but a 
plan of training was worked out by a committee in 
the beginning of 1909 to be submitted for approval 
by the government . This plan advocated a two years ' 
course with three months' preliminary training. 

The association of nurses founded in 1 898 has done 
much towards fostering a true spirit of good feeling 
and comradeship between its hundreds of members, 
and still more has been accomplished by our little 
nursing magazine, Epione, to the beginning of which 
the impetus was given by Sister Agnes Karll's words 
uttered in 1907 in Paris: 'Only get a nursing paper, 
and all the rest will come.' ! 

The nursing association in Finland, besides manag- 
ing the preliminary school and home for probationers, 
collected money in 1909 for a fund to help sick nurses, 
and prepared to start this caisse de secours without 
delay. A couple of years later, it laid plans to 
initiate district nursing, and in 1912 the first visiting 
nurse under the auspices of the society was put in 
the field. It is intended to extend this service, and 
to make propaganda for public school nursing. 



276 A History of Nursing 

The entrance of Finnish nurses into organised relations 
with those of other countries was largely the work of 
Mme. Mannerheim, whose English training had ac- 
quainted her with the nursing movement in general. 
She came to the Paris Conference in 1907, where she 
took all hearts by storm, and returning home, so suc- 
cessfully inspired the nurses of Finland with the idea of 
international co-operation that in 1909, in London, the 
national association was represented by a splendid dele- 
gation and came into membership in the international 
group. 

Norway. In Norway, as in Sweden, the Red Cross 
is eminent in nursing work. Here, indeed, it seems 
supreme, as all nursing education and nursing ex- 
tension worthy the name are evidently carried on 
under the auspices and by the efforts of the society. 

Norway was one of the first countries to adhere to 
the treaty of Geneva. Her society was formed in 
1865, but though relief was generously given in the 
wars of 1870 and 1877, and though the scope of 
activity was enlarged in 1892, the society then under- 
taking to distribute grants of financial aid made by 
Parliament to the parents of men killed in war, it 
was not until 1894 that the Red Cross Society of 
Norway began the systematic training of nurses. 
A home was established in 1895 an d> while in training, 
the pupils are sent, after a six to ten weeks' probation, 
to different hospitals for general nursing, contagious 
diseases, obstetrical service, and surgical experience. 
They are also given a service in a tuberculosis sana- 
torium. The course of training lasts for one year 
and a half and is completed by a service as staff nurse 
in the home of the Red Cross Society. The first year 




Sophie Mannerheim 
Matron, Surgical Hospital at Helsingfors 



Northern Europe 277 

is regarded as a school year, the pupils paying a small 
monthly fee, while in the half year following every- 
thing is provided for them free. The courses in 
theory are terminated by examinations. Besides the 
central school, the society carries on a number of 
branches in different parts of the country. The 
pupils must be strong, well educated, refined, and of 
high character. They are admitted between the 
ages of twenty and thirty-five, about twenty-four 
being accepted each year. 

The Red Cross not only undertakes to supply 
nurses in war time, but also for private duty in time 
of peace. It therefore builds hospitals, staffs them, 
and organises the work of private duty registries. 
District nursing, too, comes within its range of 
undertakings, and Red Cross nurses are sent to the 
poor in their homes, as well as to assist in times of 
disaster or calamity from any cause. Finally, they 
are detailed to the campaign for the extinction of 
tuberculosis, which was initiated in 1899. Here they 
act as visiting nurses and teachers of hygiene and 
food preparation, and see to disinfection and the 
details of isolation of cases. 

In the first eleven years of its work in training 
nurses, the. Norwegian Red Cross educated two 
hundred and thirteen Sisters, of whom one hundred 
and sixty-five were to be ready at a moment's notice 
in case of mobilisation. However occupied, every 
nurse sends in a yearly report of her work. 

The nurses who came from the north countries 
to the London Congress in 1909, wearing their uni- 
forms with their Red Cross badges and brassard 
or their hospital brooches, were the most ideal set of 



278 A History of Nursing 

women for their calling that one could wish to see; 
tall, fair, and fine-looking, their faces beaming with 
good and gentle strength of character. If the stories 
of their profession seem short in comparison with 
others, one must wonder if it is not because a uni- 
formly high standard of education and character 
among the people of their countries, resulting in a 
chosen class of women as nurses, gives less to be dis- 
satisfied with, creates an ethical atmosphere, where 
friendly co-operation thrives and strife is needless? 





A Norwegian Red Cross Nurse 




CHAPTER IV 

THE REVOLUTION IN FRENCH HOSPITALS 

IN January, 1908, a dramatic episode took place in 
the courtyard lying hidden between the grey and 
gloomy wards of the Hotel-Dieu of Paris. A little 
group of nuns of the order of St. Augustine, the last 
ones left in the hospital, were about to leave it, as far 
as they knew, forever. A long-expected decree of 
the Municipal Council had made known to them the 
termination of their twelve hundred years of service 
there. For some time the laicisation of the hospitals 
had been going on, and the last ones to leave were the 
Sisters of the Hotel-Dieu. In silence they listened 
to the decree of banishment. With courteous kind- 
ness and real sympathy, the Director General of the 
Assistance publigiie of Paris addressed them in fare- 
well, endeavouring to lighten the heavy moment with 
conciliatory words of recognition for their long years 
of faithfulness. Those among them who chose to 
give up their vows, he said, might remain in their 
posts, due regard being had for their fitness, age, and 
length of service. Outside the walls a crowd had 
gathered. Some possible disturbance was feared and 
the police were there. Sympathisers wished to take 

out the horses from the Sisters' carriages and drag 

279 



280 A History of Nursing 

them themselves, but this the police forbade. 
Presently the Sisters came out, entered the carriages, 
and drove away. One or two cries of ' Down with 
the Republic !' : were heard and several arrests were 
made before the groups dispersed. 

More than one revolution had taken place in the 
nineteenth century, but, passing over those of politi- 
cal import, let us pause to acknowledge one of the 
greatest the world has seen the revolution in medi- 
cine. In the fair land of France, in the year 1822, 
was born an infant who later, as a "'grave, sincere, 
almost shy youth of unobtrusive manners, ' ' came to 
Paris to study chemistry. This was Louis Pasteur, 
whose life-work was to be the reconstruction of medi- 
cal science, though he himself never studied for a 
medical degree. 

There were strange opinions held in that day, such 
as, for instance, that physiology was of no utility in 
medicine, but was only a science de luxe which could 
easily be dispensed with. The discoveries of Pasteur 
laid the groundwork of modern preventive medicine. 
He felt this, and wrote in 1877 to Bastian, one of 
his opponents : ' Do you know why I consider it so 
important to combat with and to defeat you? It is 
because you are one of the special believers in the 
medical doctrine of the spontaneity of diseases, which 
is, in my opinion, fatal to the progress of the healing 
art" 1 Pasteur's studies in spontaneous generation, 
begun in 1860, resulted in his famous dictum: 'No 
life except from previous life. ' Whatever wonders 
science may yet have to discover, this dictum will 
always hold good in the practical details of the treat - 

1 Life of Pasteur, by Rene Vallery-Radot, Vol. II., p. 31. 



Revolution in French Hospitals 281 

ment of disease, and for the procedures of the nurse. 
He acknowledged reverently a remoter mystery 
which he did not attempt to solve. 

It was he who brought Lister's attention to the 
germs of putrefaction and thus initiated the surgical 
revolution. Pasteur and Miss Nightingale w r ere con- 
temporaries, their early years of study and action 
were almost simultaneous. Each was a seer and 
prophet of health and of disease-prevention. Like 
two noble pillars, the life, the work, the teaching of 
Pasteur and of Miss Nightingale stand side by side. 

A strangely impressive picture must have been 
that of the long, bare wards of the Hotel-Dieu in the 
days of the first experiments for rabies. Full of 
humanitarian compassion as well as anxious scientific 
preoccupation, Pasteur went there daily to visit the 
patients under treatment. Gravely and courteously 
he greeted the black-robed Augustinian Sisters on 
his way down the ward. Then seemed the past and 
future to meet personified. 

The long period of depression, which in another 
volume we have called the dark period of nursing, 
was felt no less in France than in other countries. 
The nursing standards of the religious orders stood 
still or even declined, restrictions upon their rational 
activities increased, and the care of the sick fell more 
and more into the hands of a low 7 order of "mercena- 
ries," or ignorant and venal caretakers. Efforts to 
bring back a fresher spirit and set the religious orders 
free from regulations that interfered with genuine 
nursing work had not been lacking. Abbe Feraud, 
of Marseilles, comprehending the force of the criti- 
cisms directed against the Sisters, instituted an order 



282 A History of Nursing 

designed to do real nursing. Its members were to be 
selected from among the rescued foundlings, and 
they were to be dedicated to poverty but to take no 
other vows. Their training was to be given them 
by the Augustinians. Founded in 1840, this order 
gave good service for a time, but fell into decay 
because of internal dissensions. By 1890 only two 
of its members were left. Another strictly nursing 
order founded in 1840 was that at Troyes, the Sceurs 
de bon Secours. Their work was to be thoroughly 
practical and unhampered, but, like most orders with 
a solid basis of training, these Sisters w r ere entirely 
taken up with private duty. 

Within the great public hospitals a series of 
changes took place, as described in the following 
article by the Director General of the Paris hos- 
pitals, M. Mesureur: 

It was in the eighteenth century, that the first attempt 
was made to organise a graded service in the general 
hospital called La Salpetriere. [This hospital, founded 
by Saint Vincent de Paul, had always had a secular staff 
of attendants.] The superior posts were to be assigned 
to young women or widows devoid of fortune, or retired 
from the world. The regulation of the service was quite 
remarkable and still deserves consideration. The dif- 
ferent women heads [of departments or wards] were to 
be under the direction of a woman Superior, she being 
in turn responsible to the hospital directors, a majority 
of whom were members of Parliament. Under the 
control of women supervisors there were placed two sets 
of attendants: the ward maids (filles de service} and the 
nurses (filles de malades], the latter being attached 
especially to the service of the sick. 

The difficulties of recruitment at first experienced 



Revolution in French Hospitals 283 

were soon replaced by others of the opposite kind. The 
personnel became too numerous, and the profession, if 
such it could be called, became the refuge for all who were 
destitute or morally wretched, and instead of nurses 
there were only hospital hangers-on of a special kind. 
During the first half of the nineteenth century, from 1802 
to 1849, no one knew how to obviate the physical, 
intellectual, and moral inferiority of the hospital attend- 
ants. The suggestion was made that these paid servants 
might be replaced by orphans from the asylums, but this 
was not acted upon. In 1836 a reorganisation was 
effected which created a hierarchy of attendants and 
supervisors, eight grades in rank being established, with 
wages rising according to the grade. This reform had 
little effect. Medical committees continued to register 
complaints of the unreliability, incapacity, and immor- 
ality of the ward nurses, and the nuns who were in 
charge of the hospitals made no attempts to instruct or 
discipline them. 

[Here, in justice to the Sisters, it must be noted that, 
as they had little authority over the servant nurses, 
these being selected, placed, and paid by the civic 
authorities, they could not possibly discipline them, 
although discipline was always the Sisters' own 
strong point. And, with no real control, teaching 
was also impossible, even had they possessed the 
knowledge.] 

In 1845 a more definite attempt was made. The 
engagement of employees was regulated by statute; 
premiums were given to night watchers for length of 
service, and old-age pensions or a home with living 
expenses were provided for all. Unfortunately wages 
were not raised, and the attempted reforms had little 
result. 



284 A History of Nursing 

The law of 1849, which is still in force in the Department 
of Public Charities, effected a complete centralisation of 
power and placed the affairs of the hospitals under one 
responsible head. This new organisation had an im- 
mediate influence upon the hospital service. Individual 
records of the employees were now kept, and each one's 
character and fitness were noted. Nevertheless, the 
evils so often pointed out persisted. The nursing staff, 
lacking special aptitude, and devoid of professional 
training, remained insubordinate, unstable, and immoral. 
The necessity of reorganisation was brought before the 
supervisory committee of the budget of 1861, and a 
thorough-going alteration of rules, covering all the details 
of service, resulted. In the twenty years that followed, 
these regulations have been modified or elaborated by a 
series of reforms, all having as their object the improve- 
ment of the nursing personnel. 

Before going further with M. Mesureur's story, we 
pause here to do honour to a woman whose life 
redeemed the untrained sisterhood, a nurse of the old 
order, one of the uncanonised saints. In 1891 
French and English journals noted the ceremonies 
held at La Salpetriere in observance of the fiftieth 
anniversary of hospital service of Mile. Bottard. 
On this occasion, great physicians and officers of the 
government vied with one another in eulogising a 
plain and unpretending woman of native genius and 
goodness. Charcot himself arranged the programme. 
M. Montreuil, the director of the hospital, read a 
poem of his own composition lauding her beneficent 
life, and she was decorated with several medals, 
including the coveted cross of the Chevalier of the 
Legion of Honour. Shortly before, the French 



Revolution in French Hospitals 285 

Academy had given her a prize of three thousand 
francs in recognition of her lifetime of useful devotion. 
Maman Bottard, or 'the wrinkled glory of the 
Salpetriere, " as she was called, came from a peasant 
family and at the age of eighteen, in the year 1840, 
entered the Salpetriere as a servant. But she so 
soon showed remarkable gifts for managing the 
nervous and insane that she was promoted to the 
nursing staff. She had acute insight and native 
wisdom, as well as a most loving spirit in dealing 
with the patients. It is said that she was the first 
to distinguish between epileptics and the insane 
and to classify the latter separately. ;< Great men 
like Lelut, Falret, Peyron, and Voisin consulted 
with her, giving her the highest posts in the wards, 
and finally the celebrated Charcot made her the 
Directress- General of his department, which is the 
great centre of study for treatment of nervous 
disorders in France." 1 She completed sixty-one 
years of active nursing service before she retired to 
finish her life in the hospital to which she was so 
fondly attached. [According to the regulations of 
Mazarin, a hospital bed with board was to be granted 
to nurses of the Salpetriere who had completed 
twenty years of service there. She earned hers three 
times over.] When she died she was buried with 
military honours and a long train of distinguished 
men followed her coffin to its resting-place. She was 
spoken of in the daily papers as the senior secular 
nurse of the world, and as having broken all records 
of long and loyal service in the hospital since its 
foundation in 1656. 

1 E. R. W. in British Journal of Nursing, January 5, 1907. 



286 A History of Nursing 

We return now to the interrupted narrative of M. 
Mesureur. 

The Municipal Council of Paris, after repairing the 
disasters of the war of 1870, undertook to reorganise all 
the city departments. That one called the Assistance 
publique, in whose care were all the dependents of the 
city, was the object of their special solicitude. A group of 
progressive men, chief among whom was Dr. Bourneville, 
realised that the true reform needed was to teach and 
train the staff of attendants in the public institutions 
and to elevate their moral standards. For this purpose 
the first schools for ward attendants were established. 
. . . Regulations framed in 1903 raised the whole 
scale of wages, limited the hours of work to twelve daily, 
with meals provided by the hospital, allowed yearly 
vacations of from twenty-one to twenty-five days, free 
medical treatment for all, and leave, with wages, for 
women before and after confinement, and for men during 
military service. Those suffering from tuberculosis may 
receive sick pay for almost three years, and our women 
nurses have a sanitarium and convalescent home. 
Finally, retirement on pension is assured to all. 1 We 
are steadily improving the nurses' food and quarters; 
the old dormitories are being abolished, and nurses living 
outside the hospitals have an allowance for living ex- 
penses ; the moral dignity of the staff is safeguarded and 
encouraged by the presence of its representatives on a 
Council of Discipline, and by the award of honours from 
the Republic for devotion to its sick namely, medals for 
service in epidemics, and the medal of honour of the 
Assistance publigue. At the present time, our efforts 

1 After fifteen years of service, the pension paid is 310 francs, or 
about $60, yearly; after thirty years or more, 650 francs; or, those 
preferring a ward bed and board for life are thus cared for, the 
women in the Salpetriere and men in the Bicetre. 



Revolution in French Hospitals 287 

are bent upon a better system of selection of our feminine 
personnel. We have instituted a preliminary training at 
the Salpetriere and, finally, we are about to open our 
School for Nurses. . . . Upon the threshold of this 
school I will end this brief summary. . . . * 

The outline thus drawn is now to be filled in by 
approaching more closely to individual characters, 
and first to appear is the virile and picturesque figure 
of Dr. Bourneville, one of the most distinctive and 
easily the most militant among medical pioneers of 
hospital reform. A prominent specialist in nervous 
diseases, he was an ardent republican and free-think- 
ing, even revolutionary, radical. As scientific medi- 
cal man his list of achievements is long and notable. 
As radical civilian he was, in his prime, an active 
worker for municipal sanitation and hygiene. He 
held a seat on the city council of Paris, and while in 
this office succeeded in having the municipal nursing 
schools opened which he had earlier tried to secure 
through Talandier, another councillor. His battle- 
cry, indeed his religion, was that education should be 
free, universal, and secular. But he idealised instruc- 
tion and comprehended less well the subtle essence 
of training. He was fully sympathetic with nurses 
on the economic side. For over thirty years he made 
the cause of the downtrodden and oppressed attend- 
ants, men and women, of the Paris hospitals, his 
special crusade, championing them in and out of 
season, with unfailing energy and disregard of all 

1 L'CEuvre de I' Assistance Publique de Paris dans fEnseigenement 
des Infirmieres. By M. G. Mesureur, Director General of the 
Department; in Reports, International Conference of Nurses, Paris, 
1907. 



288 A History of Nursing 

personal sacrifices. The municipal schools in the 
hospitals were his dearest life-work, but in his passion 
for instruction he threw open the classes, lectures, 
and certificates to all the subordinates of the hospital, 
so that the cart-drivers, stretcher-boys, orderlies, and 
men in the store-rooms might and did study for the 
certificate of the nurse. He welcomed also students 
from the outside laity; women of leisure, desiring 
some medical notions for private life, or wage-earning 
women, hoping to take up private nursing. Many 
private nurses in Paris have had no preparation 
for their work save the theoretical course of the 
municipal schools and the brief indefinite privilege 
of 'walking the wards" that went with it. But 
rudimentary as these schools were, the difficulties 
under which they were carried on make them unique 
in hospital history. When they were founded, few 
of the pupils could read and write ; this must be first 
taught; then the courses were not compulsory, so 
that only moral suasion and appeals to ambition 
could be resorted to, in bringing out the weary, over- 
worked ward staff in the evenings; finally, as there 
were only four centres of instruction, pupils had to 
travel long distances from one hospital to another. 
Under such circumstances, both pupils and teachers 
command admiration and respect. 

To the Paris nursing conference came Dr. Bourne- 
ville in person, venerable, but still militant, to read 
there the story of his long and often single-handed 
warfare for nursing reform. From this somewhat 
prolix narrative, listened to at the last with some 
impatience by those of the younger generation, we 
take what follows : 



Revolution in French Hospitals 289 

How did I come to occupy myself with the question 
of the instruction of nurses? I recall two incidents: 
In 1862, I was an externe in the surgical service of the 
Hospital for Sick Children. An operation was being 
performed upon a newly-born infant with imperforate 
anus. Mother P , a woman in her forties, in handing 
the instruments turned her face away and held a hand 
before her eyes in order not to see the field of operation. 
This singular attitude caused me to reflect upon the 
manner in which the religious Sister regarded her func- 
tions as nurse. Was this the exception, or was it the 
rule? 

Again, in 1869, in making rounds one morning, we 
found a man with acute heart disease sobbing in deep 
distress. Questioned by Professor Hardy he said: "Am 
I really very ill? Am I going to die?" "Why do you 
ask?" 'The Sister brought the priest without my 
asking, and he gave me the last sacrament. " 

During this period I had read the articles in the Lancet 
upon the English nurses and their training. The develop- 
ment of our schools of instruction came about in the 
following manner. In 1871, I wrote a letter to Charles 
Delescluze upon the organisation of instruction, with the 
purpose of preparing efficient nurses to replace the Sisters. 
In 1877, I went to London as one of a delegation from the 
municipal council. I took advantage of this oppor- 
tunity to visit hospitals. At the Westminster Miss 
Merryweather gave me full information regarding her 
school and the others in England, and, armed with this 
knowledge and ready to act, I succeeded in having a 
resolution passed by the Municipal Council in December, 
1877, a few months after my visit, authorising the crea- 
tion of schools for nurses. 



I had been led by the incidents previously mentioned 
to observe the nuns carefully, as well as their auxiliaries, 
the servant nurses and the chaplains, in their relations 

VOL. III. 19 



290 A History of Nursing 

to the sick, the medical staff, and the administration 
to take their history just as we took those of our patients. 
. . . These observations may be summed up as follows : 
The nuns: little time given to the wards; much spent in 
religious exercise. Little or no personal care given to 
patients, especially as concerned necessary attentions to 
the genital zone ; refusal to nurse venereal cases, lying-in 
women, and unmarried mothers. These were left en- 
tirely to the servant nurses. . . . Meagre respect for 
administrative rules. The Superior or prior came be- 
fore the physician or the directors; the soul was more 
important than the body. Thence the necessity of 
laicisation. . . . Religious services were undertaken by 
the parish priests and every care was taken that patients 
desiring the solace of religion should be fully satisfied 
under the new system. My observation of the nuns 
showed me that the majority of them, aside from 
certain wealthy convents with a large dowry require- 
ment, were recruited from the bourgeoisie, had had only 
a very limited primary education, and that their train- 
ing for nursing was limited to a more or less bad routine, 
accordingly as they had been trained under a more or 
less intelligent Superior. The Sisterhoods were often 
both teaching and nursing orders, and the less in- 
telligent, less well-educated Sisters were retained in the 
hospital. . . . 

The nurses: observation of the attendant nurses 
showed me that many, both men and women, were 
illiterate, that a very few had had some little instruction, 
and that the material circumstances of their life in 
the hospitals were deplorable in many respects. I as- 
sured myself of the abominable state of their rooms, 
the insufficiency or bad quality of their food, and, in 
addition to the idea of creating schools of instruc- 
tion, I framed a programme for ameliorating all the 
material, moral and intellectual circumstances of the 



Revolution in French Hospitals 291 

entire secondary personnel the under employees, and 
the nurses, men and women. This programme included : 
(i.) Improvement of the way they were lodged, doing 
away with dormitories and providing single rooms, 
comfortably furnished in conformity with hygiene, so 
that they would prefer them to the saloons and the streets. 
(2.) Improvement of their food. (3.) Improvement of 
wages, which, in 1878, the Municipal Council raised from 
15 to 25 francs. (4.) Better provision for pensions. (5.) 
Finally, the schools of instruction. 

It was thought best to place them at first in those 
hospitals having secular head-nurses and supervisors, 
and the choice fell upon Bicetre, with 235 nurses, and Sal- 
petriere with 393, where there were already primary 
teachers for the retarded children. The services of these 
teachers could be utilised, and thus the argument of 
expense, advanced by the opponents of instruction, was 
met. The school at Salpetriere was opened on April I, 
1878 ; that of Bicetre on May 2oth, and Pitie on May 24th 
in the same year; that of Lariboisiere on December n, 
1894. 

Six months after the first course was started, an 
English physician who had taken Dr. Bourneville 
about in London came to Paris and described his 
impressions of the problem to be solved. His general 
tone is pessimistic, but he adds: 'I went to the 
lecture. The class was earnest, the lecturer enthusi- 
astic. They feel it a truly missionary work." 1 

An interesting thing was the response of the nuns 
themselves. ' When the schools were first started, ' 
said Dr. Bourneville, 'they avoided the instruction 
courses ; then some came in civil dress, unobtrusively, 
and at last they came openly, officially. Every year, 

1 E. H. in British Med. Journ., Sept. 7, 1878. 



292 A History of Nursing 

from 1898, a group of from eight to twelve cloistered 
nuns from the Hotel-Dieu came in carriages to the 
Salpetriere. ' 

The course of instruction comprised simple out- 
lines of anatomy and physiology, hygiene, minor 
surgery and dressings, materia medica, obstetric 
nursing and care of the newborn, massage, and the 
care of the insane. The teaching of anatomy was 
severely criticised, though Dr. Bourneville said that 
what was taught should be known by every school 
child. Much criticised too were the lectures called 
"hospital administration, " treating of hospital rules, 
ward housekeeping, details as to patients' clothing, 
hospital linen and equipment, disinfectants, the 
ordering of ward supplies, the general duties of 
nurses, what to do in case of death, etc. It seems 
quite incredible that instruction of this kind should 
have been objected to as unnecessary for nurses. 
Dr. Bourneville rightly insisted that it was indis- 
pensable. 

There were also lectures on the organs of special 
sense and their diseases ; nutrition and diet ; the signs 
of death; modes of burial; infant feeding; and the 
perils of tuberculosis, venereal disease, and alcohol- 
ism. Brilliant and enthusiastic medical teachers 
brought their best to these discourses, painstakingly 
lavishing on the unlettered pupils a scientific nomen- 
clature that they could not understand. The courses 
were given with blackboards, manikins, skeletons, 
and objects. Within certain bounds, Dr. Bourne- 
ville must be fully credited with upholding the teach- 
ing of nursing by nurses, for practical lessons were 
given daily by selected head-nurses in the wards, the 



Revolution in French Hospitals 293 

pupils coining to them in groups. Some of these 
lessons were well, others carelessly, given, the head- 
nurses being busy or tired. Those who were con- 
scientious were always appreciatively mentioned and 
thanked in the annual reports written by Dr. Bourne- 
ville. Once a week all pupils were to rehearse under 
the eye of their teacher what they had been taught, 
and to put it into daily practice in their wards. The 
externe pupils had the same routine, though their 
ward work was very limited. To meet class needs, 
Dr. Bourneville, with the collaboration of the pro- 
fessors, prepared a nursing manual, using as a founda- 
tion a handbook written by an English nurse. * The 
first edition of this manual should be a treasure for 
collectors, for, in order that it might be easy to read, 
it was printed in large type like a child's primer. 

Though Dr. Bourneville might have seen how 
indispensable a part the English hospital Matron 
played in English nursing, he left her out of his plans 
for the Paris hospitals. Whether this was from a 
failure to understand, or from love of dominance, or 
belief that Paris was not ready for her, we do not 
know, because he never mentioned her at all. But 
from the testimony of those who knew him it seems 
probable that, with benevolent and paternal self- 
sufficiency he believed himself able to administer a 
satisfactory nursing system, and would not have 
liked giving a Matron the place she held in England. 
Kindly and appreciative in his demeanour to the 
nurses, their status allowed a much greater conde- 
scension and familiarity than was the case in Eng- 

1 Handbook for Nurses for the Sick, Zepherina P. Veitsh, London, 
1876. 



294 A History of Nursing 

land. It was usual, for instance, for the nurses in 
Paris to be called by their first names. 

The annual reports of the municipal hospital 
schools show that for full thirty years he insisted 
steadily on the need of rotation in service for the 
pupils, reform of night duty, better rooms, food, 
and pay for the nurses, and that he always urged the 
importance of sitting-rooms, libraries, and museums 
of nursing appliances, a long record for which he 
deserves lasting recognition. His weakness was that 
like many reformers he was hostile to every advance 
that went farther than his own. Sincere and militant 
as he was, he had a childlike vanity that made him 
sensitive to criticism, and he died wounded by the 
evidence that his work had been but one stage of 
progress and not its complete realisation. After his 
death Dr. Hamilton wrote of him : 

He was a convinced pioneer. . . . Though we have dif- 
fered widely from him as to methods . . . we recognise 
the sincerity of his convictions, his perseverance, readi- 
ness in combat, and the nobility of his essentially demo- 
cratic ideals. . . . The bitter warfare which he carried 
on with the Church was detrimental to him, as it caused his 
adversaries to regard him rather as the apostle of atheism 
than as the physician desirous of providing the sick with 
competent attendants. It is infinitely regrettable to 
bring questions of religion into the reorganisation of 
hospitals, which should be undertaken solely with the 
aim of giving the sick the best care. Bourne ville seemed 
rather to wish to drive the Sisters out of the hospitals 
because they were nuns, than to substitute secular nurses 
because they were competent. 

To his story of the beginnings must be added that 



Revolution in French Hospitals 295 

of Mme. Gillot, a kind and sweet woman who, as 
head teacher of the children on the hospital domain, 
was put in charge of the primary education of the 
nurses. 

Fifteen years ago the Salpetrire was entirely unlike 
any other of the hospitals of Paris. Its distance from 
the centre of town, its important buildings, its immense 
gardens and its beautiful avenues of old trees, gave one, 
on entering, the impression of a pretty little provincial 
town where the mind could repose in perfect calm. . . . 
The staff was composed of two distinct elements. The 
first consisted of young girls from the provinces, Bretons 
for the most part, who had been called to the Salpetriere 
by their friends or relations already employed there. The 
second element was composed of those families, parents 
and children, who during perhaps three generations had 
all been continuously in the service of the hospital. It 
is easy to imagine the profound dissimilarity between this 
staff and that of the other hospitals. Trained by tradi- 
tion, one might say, the nurses of the Salpetriere followed 
in the steps of their predecessors, attached themselves 
to the institution and often refused all preferment rather 
than leave it. In 1835 an elementary school had been 
established for the nurses, but it had been discontinued 
in 1845. . . . When, in 1878, it was decided to open a 
school for the professional instruction of the nurses, it 
was realised that few of the staff would be capable of 
profiting by the lessons. The elementary school was 
therefore reopened in April, 1878, with sixty pupils. 
Classes were held every evening. The pupils were 
divided into two groups, and these, again, by reason of 
the inequalities in their education, were each subdivided 
into several smaller ones. Most of the girls could neither 
read nor write, and a good many of them, by reason of 



296 A History of Nursing 

their Breton origin, could not even speak French. In 
1888, of seven hundred and twenty-eight pupils who had 
taken the professional course, two hundred and ninety- 
three had acquired all their elementary instruction in the 
hospital. In 1891, the organisation of the school 
remained the same. . . . But the law on compulsory 
education had now begun to show results. Illiteracy 
was diminishing, and a more general foundation of study 
enabled us to prepare the better pupils for the certificate 
of primary studies. The programme followed in these 
schools was the usual primary instruction for adults. 
But we endeavoured to make this a preparation for the 
professional instruction by taking" the dictations, reading 
lessons, etc., from the Manual of Nursing which Dr. 
Bourneville had prepared, and by selecting the same 
subjects which were being treated by the professors in the 
lectures. The primary studies thus served, to a certain 
extent, as "quizzes" for the professional lectures, and 
the teachers were often enabled to explain points not 
clearly understood by the pupils. This teaching, how- 
ever, would have seemed very incomplete to us if it had 
not included moral instruction. All the teachers, in- 
cluding myself, took advantage of every opportunity to 
inculcate in our pupils' minds a high ideal of their 
mission, to inspire them with an absolute professional 
probity, and to encourage them to maintain a bearing 
that would command confidence and respect. We 
impressed upon them the importance of the spiritual 
qualities of the nurse and often a naive reflection and 
apt comment showed us that our words were taken to 
heart. . . . 

Toward the end of the nineteenth century, the 
question of finding openings to self-support for re- 
fined young women was one that gave much thought 



Revolution in French Hospitals 297 

to educators. The principal of a girls' high school 
at Versailles, Mile. Allegret, keenly interested in the 
future of her pupils, to whom little but the already 
overcrowded profession of teaching was open, came 
to the conclusion that nursing offered an alternative 
of great possibilities. It was largely due to her that 
a numerous group of men and women, chiefly philan- 
thropists and teachers, with Mme. Alphen-Salvador 
as president, opened the private nursing school known 
familiarly as the school of the Rue Amyot. This 
was the first attempt made in France to introduce 
what was called in England, in the early days, the 
"Lady Nurse. ' A pleasant and refined home com- 
bining many of the features of a school was provided 
for the pupils, under the direction of a gentlewoman, 
who, however, was not a trained nurse nor familiar, 
with the work of nurses. 

The society, called the Association for Developing 
Aid to the Sick, instead of trying to enter their pupils 
in some one of the large hospitals, founded ten hospi- 
tal beds for pay cases and opened a dispensary for 
free patients to supply the pupils' practical work. 
At first the experiment promised well. A well-bred 
class of young women entered, full of enthusiasm over 
the new career. But the school never developed on 
the practical side. There may have been several 
reasons for this : the woman at its head not being a 
nurse may not have known how to advise; the 
directors of the public hospitals may not have wished 
to open their wards to it. (M. Mesureur, at one of 
the annual meetings, intimated that he would will- 
ingly give the school a set of wards, but could do so 
only with the consent of the chiefs of staff. Sec 8th 




298 A History of Nursing 

report of the association.) Or the doctors may not 
have realised the need of hospital experience. Dr. 
Rist, one of the lecturers at the Rue Amyot, said in 
one of his addresses that the Paris hospitals were not 
suitable for training. But above all was the manage- 
ment at fault, in being satisfied to gain permission 
for their pupils to 'walk the wards" like medical 
students, for a few hours daily. This, of course, was 
more than useless. An observer, seeing a group of 
these pupils one day in a large hospital took them 
for medical ext ernes. One sat down to read while 
waiting for rounds to begin; several others chatted 
together; when rounds began they attended and 
heard diagnoses made, watched operations, and 
examined patients who were dirty, ill-kept, and ill- 
cared for. 

The Rue Amyot school has, with time, developed 
into a private nursing institution rather than into a 
training school. Its own students form but a small 
group, and certificated nurses from other countries 
are taken on for private duty. 

As, in England, a long series of slowly advancing 
steps had been taken before Miss Nightingale came 
on the scene, so in France the standard-bearer of 
complete and triumphant nursing reform appeared 
at the end of a generation of tentative effort. At the 
Paris Conference of 1907, the foreign visitors looked 
with deep interest at a slight, simply-clad, quiet 
young woman of few words and reserved manner, 
who was accompanied by a group of nurses dressed 
in uniform and of irreproachable refinement of bear- 
ing and appearance. When her turn on the pro- 
gramme came, she read the briefest possible account 



Revolution in French Hospitals 299 

of the Bordeaux training schools for nurses. It was 
Dr. Anna Hamilton, author of the famous thesis on 
nursing which had been published in 1900, and had 
had almost the effect of a bombshell in French hos- 
pital, medical, and administrative circles. This was 
the woman who had quietly introduced the " Night- 
ingale System" into Bordeaux and set the boundary 
line between two eras of nursing. Unassuming as 
she appeared, the extraordinarily keen steadiness of 
her eye declared an indomitable spirit, and when, in 
tranquil tones, she pronounced the words: 'The 
school of nurses is attached to a hospital and consti- 
tutes its nursing staff. A woman directs the hospital 
and training school. We hold that the value of 
training depends on these two points,' every one 
knew that a gage of battle had been thrown down 
before the assembled hosts. 

Dr. Hamilton had studied medicine with high 
ethical, even religiously serious, purpose, but the prac- 
tice of medicine as she saw it in the wards of hospitals 
so revolted her that, shocked by the callousness of 
the medical students and the coarseness, even 
brutality, of hospital procedure, she had almost given 
it up, when, arriving by her own reflections at the 
conclusion that the care given to the patient might 
be organised on a moral, intelligent, and sympathetic 
system, and that medicine might then become truly 
beneficent, she decided to take the subject of hospital 
nursing for her thesis when going up for her medical 
degree. This thesis, for which she travelled far and 
wide and, with personal research, visited and exam- 
ined hospitals in other countries and at home, is a 
complete history of nursing orders, systems, princi- 



300 A History of Nursing 

pies, and standards, richly illustrated and containing 
a copious bibliography. Beginning with an outline 
of the care given to the sick in pagan and in early 
Christian times, it makes a thorough critical and 
comparative study of all the varying systems of 
nursing in existence at the time of its writing, the 
merits, shortcomings, and defects of each being 
examined and pointed out with scientific accuracy. 
Judgment is fearlessly pronounced, no matter how 
dangerous the ground trodden upon. Constructive 
recommendation is clearly put forth. The book is a 
landmark in French nursing history. x 

Dr. Hamilton's own story is now to be told: 

I was 'born in May, 1864, in an old country house on 
the slope of the hill near Florence, which had been a 
convent belonging to the Medici. I have a small bronze 
bell which was found by my father when some dig- 
ging was being done, with the coat-of-arms, the six pills 
under a crown, of the Medici princes. Oddly enough, 
the one brother and myself who were born in that house 
both studied medicine. ... In 1876, we went to live in 
Bordighera. . . . My father lost his fortune, and I learnt 
all kinds of household duties from my mother, who was 
French. For many years economy was the watchword, 
and of four daughters (two elder at school or more or 
less away and a younger one) I was the only one who was 
supposed to be responsible for housekeeping and all sorts 

1 Considerations sur les Infirmieres des Hopitaux. These presente 
et publiquement soutenue a la Faculte de Medecine de Montpellier. 
8, 335 pp. Imprimerie Centrale du Midi, Montpellier, 1900. As a 
thesis is not sold and can be found only in libraries, Dr. Hamilton, 
later, in collaboration with Dr. Felix Regnault, prepared a somewhat 
similar but smaller book called Les Gardes-Malades Congreganistes, 
Mercenaires, Professionnelles, Amateurs. Vigot Freres, Paris, 1901. 




Doctor Anna Hamilton 

Founder of the " Florence Nightingale Sy; 

Reading her Thesis at Montpel|rer 




Revolution in French Hospitals 3 01 

of trades besides. This explains how, though a physician, 
I know the practical duties of life. But my mind was 
hungry; I felt the emptiness of it all and longed for in- 
tellectual work. Then it was that I took to reading the 
medical books in my father's library. He had at one 
time wished to study medicine himself, but my Irish 
grandfather, hearing about it, was very much angered and 
said he would disinherit him if he brought such disgrace 
on the family. . . . He gave it up, but when he saw his 
daughter reading medical books he w T as amused and said 
he would quiz her twice a week, not believing she would 
persist. But as she did, a few weeks later he proposed 
she should study medicine seriously. My grandfather 
was then dead. ... I started for Geneva to prepare there 
to enter the school of medicine. . . . The first of Decem- 
ber found me in Marseilles, a student. Relatives and 
friends were now quite startled, and some were shocked, 
for my undertaking had been a good deal laughed at. It 
was decided that intense will power had enabled me to 
succeed so far, but that brains would not allow me to go 
farther. But I went through the examination of that 
year with a "very good" and got the first prize at the 
first year competition, being the only woman among ten 
students. After that it was supposed I w r ould get my 
degree, but then I began to doubt it. Medicine was 
disappointing ; patients were not cured ; doctors explained 
more about the hidden details of disease than about the 
way to relieve suffering. Fifty-five minutes were spent 
on the disease, and five more in saying that such a 
remedy was used but was not much good. Thus it was 
that, despairing to learn to cure, I thought it ought to be 
a duty at least to soothe all unnecessary pain. I never 
had had opportunity to know nice nurses or to see pa- 
tients who had been properly nursed, until 1895, when 
I began to hear about it, but my mind being set upon 
the subject, I thought it out for myself, and studied 



302 A History of Nursing 

nursing books. Florence Nightingale's Notes on Nursing 
I most admired. Then in 1898, when I went to England, 
I was deeply impressed by all that I saw in the London 
hospitals. 

Oddly enough, Dr. Hamilton, who was to introduce 
the Nightingale system into France, was not per- 
mitted to use the wards at St. Thomas's for her 
observations, as she had hoped to do. But at St. 
Bartholomew's she found in Miss Isla Stewart a 
generous hostess who gave her the freedom of the 
wards, and, that she might not seem like an intruder, 
a broom to carry about with her. Let us pause to 
say that this was most characteristic of Miss Stewart. 

. . . My studies had been constantly interrupted. . . . 
My father had died . . . after some little time I could go 
on. ... When I took my manuscript to the president I 
had chosen more than two years before (because he was 
a good Roman Catholic, so that people should not be able 
to say my ideas were only a question of religion) , he was 
dreadful ; people had no doubt told him to beware of me. 
He said it was all wrong; this had to be taken away and 
that also, and he criticised and grumbled and at last 
proposed to let me have a thesis prepared by some one 
else, so that I might get my medical degree as quickly 
as possible and then be free to pursue my studies in 
nursing. I refused, and told him I would not hear of 
signing a thesis written by someone else, and that I was 
determined to keep this subject. ' Then you must do it 
all over"; said he. "If I must, I will.' 1 Seeing that I 
was firm he told me to leave the manuscript and come to 
luncheon five days later. The day arrived. He was 
charming, but the meal was almost over before he men- 
tioned the thesis. At last he said: "Well, I have looked 



Revolution in French Hospitals 303 

at your manuscript and after all I think it may do with 
just a few changes." He had crossed out about thirty 
lines some remarks about the Sisters and an anecdote 
about Pope Pius calling in a non-Catholic physician. . . . 
But twice he said to me, "Who wrote that thesis for you? 
You did not write that all yourself?' 1 I was greatly 
amused, for no one had in any way helped me. . . . 
I did indeed feel the value of independence while pre- 
paring it. Many people would have been happy to 
prevent my publishing such a book, but they could not 
get hold of me. Professor - declared that if I dared to 
walk into his wards again he would send me away. I did 
not give him this opportunity. I had been there many 
times, and had noted in my diary many of the disgusting 
things that could be seen there. I stopped going to the 
hospital and worked hard at my thesis. But my friends, 
too, tried to discourage me. One day I had been so 
annoyed that I was foolishly shedding tears on my manu- 
script when afeministe lady came in, and told me that all 
my trouble was a proof that my work would not be 
worthless. 

I handed in my thesis in June, 1900. I had worked all 
year on it, and it was gossiped about that I would never 
finish it ; that it was absurd ; that it would not be accepted 
on account of the menial subject. This brought a small 
crowd, about two hundred, to listen. The time was noon, 
and such proceedings usually took about fifteen minutes. 
But that day the four judges were shut up in their council 
chamber and everyone got impatient. It was one o'clock 
when they came out in their scarlet silken robes, looking 
excited and red in the face. It later got abroad that 
they had been discussing my thesis. It had been expected 
that the president I had chosen and one of the judges 
would be favourable, and the two others hostile. But 
one of the latter, receiving my thesis on the eve of that 
day, had told some students that he could not lecture to 



304 A History of Nursing 

them because he meant to demolish it completely and so 
would have to read it carefully. As it was quite long, 
it was known that he had spent most of the night in 
reading it, but was, as it turned out, entirely convinced 
by it. Quite enthusiastic, he argued for it with the 
remaining hostile judge, and they all forgot that the 
audience was waiting. . . . The discussion was hot, and 
the most controversial statements were made by the 
judges to one another. ... I passed, but the obstinate 
judge would not agree to my having a 'very good," 
being determined that I should not gain the thesis prize, 
which would probably have fallen to me, as my thesis 
was the fullest ever presented to the faculty of Mont- 
pellier, and based on personal research. The papers of 
the day had much to say about it, and urged that it be 
published for sale. 

I looked for a post in a hospital, as I meant to put my 
ideas into practice. But in Paris I met only with criti- 
cism. It was said I had angered all the Protestant 
religious party (on account of my criticisms of the 
deaconesses), all the Roman Catholic party (by what I 
had said of the nuns), all the Paris authorities (because 
I criticised the lay nurses), and all the good patriots of 
France (because I praised foreign ways) therefore, no 
wonder I got no post. ... But later I was called to Bor- 
deaux to reform this hospital, and took charge of it in 
May, 1901 . It had been for thirty- six years in the hands 
of a lady, the widow of a clergyman, and ladies with a 
hobby for nursing came here for lectures and to attend 
in the out-patient department. The wards were in charge 
of rough male servants for the men, and six young girls, 
who were much less considered than the porter's wife, 
for the women. They had no uniform, often slept in the 
wards, their food was coarse, and there was no rule as to 
off-duty time or attending of lectures. The largest ward 
of the hospital, for male cases, had three windows, two of 



Revolution in French Hospitals 305 

which had blinds that would not open, therefore neither 
sun nor air could easily get through. The beds were of 
all heights, some with straw mattresses, the bedding was 
revoltingly dirty, with brown blankets and stiff oilcloth 
for mackintoshes. On the tables near the beds were 
earthen jugs for the tisanes (medicinal teas), mostly 
broken, patients drinking out of them ; chambers or urin- 
als, food, and iron spittoons once painted green, now 
all worn out by rust. Several night-chairs stood perma- 
nently in the wards and were very unpleasant as to odour. 
Under the beds were parcels and bones; around each bed, 
in the morning, burnt matches and expectoration were 
freely scattered. The beds had posts and cross-bars, 
once used for curtains, then to hang trousers and jackets 
on. Small quilts made of rags lay at the foot of the beds 
over the brown blankets. Everything was dirty, dark, 
and untidy. Now all is changed, and our school and 
hospital quite up to the plane of the English ones. The 
patients of olden times, when they come again, are sur- 
prised and pleased. A great many people were shocked 
at my changes, and said all kinds of things against the 
new nurses, but after almost nine years' work, the worst 
enemies have been conquered. Those who were the most 
hostile now send for the "new nurses" when they are ill. 

The hospital of which Dr. Hamilton now took 
charge, the Maison de Sante Protestante, and 
where she was determined to introduce the modern 
system as soon as possible, has an interesting his- 
tory. Founded in 1863, under voluntary manage- 
ment, for Protestant sailors, it grew rapidly into a 
free general hospital, including all branches of ser- 
vice. From the outset its founders had wished to 
develop a nursing institute in connection with it. 
In 1884, the superintendent, Mme. Mommeja, urged 

VOL. Ill 20 



306 A History of Nursing 

this anew, and a year later the managers offered a 
course of training, but no pupils presented them- 
selves. The only result of the efforts made was that 
courses of lectures were started which were attended 
chiefly by mothers of families. Pleased by these 
lectures, women of leisure persuaded the Society to 
Aid Wounded Soldiers (one of several which later 
united under the Red Cross) in 1887 to grant them 
diplomas after an examination in theory given by 
physicians, and in the next three years twenty such 
diplomas were given, only three of which fell to 
women who were actually working in the wards. 
In 1890, the managers determined to give their own 
diplomas, and to create a 'Free and Gratuitous 
School for Nurses.' (The word "free" meant non- 
sectarian.) The superintendent was now Mme. 
Gross-Droz, who had taken the Red Cross lectures 
and believed herself to be trained. 

The new school was a typical one according to 
French Red Cross methods. The pupils were all 
externes, coming three times a week to lectures, and 
the only service exacted of them was to assist in the 
dispensary (out-patient department) and at opera- 
tions, where they used to come in trailing lace- 
trimmed gowns, with fingers full of rings, expecting to 
do only the interesting things and having no intention 
whatever of cleaning up. Mme. Gross-Droz, having 
no comprehension of what nursing really was, rarely 
went into the wards. By 1901, though the school 
had given diplomas to one hundred and thirteen 
externe amateur pupils, there were only sixteen 
internes, or those who had actually worked in the 
wards, who had received it. 



Revolution in French Hospitals 307 

When Dr. Hamilton took charge, her first step was 
to put a stop to the cherished custom of allowing 
society women to crowd in at major operations, and 
to swarm over the dispensary among the patients. 
She next called upon the younger women who came 
to lectures to enter the wards and help with the 
nursing. Mme. Gross-Droz and her party were 
scandalised, holding that a young girl's prospects of 
marriage would be destroyed by doing such work. 
As it was found useless to argue with Dr. Hamilton, 
the Red Cross Society was called to the rescue, rein- 
forced by the offended women whose privileges had 
been cut off. A drawn battle followed between Dr. 
Hamilton on the one hand and the indignant ama- 
teurs on the other. They hoped to get rid of her, 
and all their social influence was bent to the effort of 
persuading the hospital managers to give over the 
dispensary and operating theatre to the Red Cross 
Society for its pupils. This would have entailed Dr. 
Hamilton's resignation. It was a difficult position 
for the managers, as the hospital was supported 
almost entirely by private contributions. To their 
great, lasting credit, after hearing Dr. Hamilton's 
statement of the moral and scientific needs of the 
patients, they decided to uphold her, and the Red 
Cross Society, being offered only such opportunities 
as could be given without disturbance of the service, 
retired. Mme. Gross-Droz resigned from the post 
of lecturer, to take up the work of teaching Red 
Cross pupils in a small private nursing home. 

Dr. Hamilton writes: 

Ladies crowded in to get the certificate of the Red 
Cross Society, which entitles them to hold the posts of 



308 A History of Nursing 

superintendents of nursing and Matrons of hospitals 
without ever having served in a hospital ward. If war 
were to come, there would be chaos. For instance, a 
contract dated 1890 exists between the Protestant Hospi- 
tal and the Red Cross, which entitles the latter, in case 
of war, to take charge of one-half of this hospital as 
Hospital Auxiliary No. 16, and to take wounded officers 
there. By the contract the regular personnel of the 
hospital would have to withdraw, and the military cases 
would be attended by a superintendent, Sisters, and 
nurses, trained in this absurd manner by the Red Cross 
Society. This is one instance of what would happen all 
over France. 

Reorganisation now went on fast. The diploma 
was given only to those who had spent two years in 
the wards. The men attendants were dismissed. 
The nurses were put into uniform, new quarters 
arranged, and a sitting-room provided for them the 
first one in France. Ladies were allowed to come to 
certain lectures, but without recognition. Finally 
things were so ordered that a trained nurse could be 
called in to organise a school, for Dr. Hamilton had 
insisted from the first that physicians could not 
teach nursing. A Dutch Sister was first called ; then 
two Swedish Sisters, but without success; finally, 
the entente cordiale having been established, she 
was free to bring in an English nurse this having 
been at first refused her as impossible for the Boer 
War had had a malign influence even in nursing work. 

In 1893, a young Englishwoman with a strain of 
French blood was studying in Paris. Hearing a 
friend's anxiety over a severe operation case and the 
difficulty of home treatment, she said naturally, as 



Revolution in French Hospitals 309 

an Englishwoman would : ' Why not send the patient 
to a hospital?' The reply, 'We never send our 
friends to the hospital in France ; even the poor spend 
their last penny before doing so,' made a deep 
impression upon the listener, and she thought to 
herself, in the half-mystic way which doubtless in 
earlier days would have been called a vow, "If I 
ever become a nurse, I shall work in France. ' The 
young Englishwoman was Catherine Elston, and in 
the same year she was in training at the London 
Hospital. 

In subsequent work from time to time, vague 
rumours of Miss Hamilton came to her as if to 
keep alive the semi-involuntary wish. One day, 
carelessly turning over the pages of a magazine, her 
eyes fell on the words "Dr. Anna Hamilton, Ecole 
Hospitaliere, Bordeaux. ' She immediately wrote 
to her to tell of her wish to work in France. By 
a curious coincidence, Dr. Hamilton had just writ- 
ten to Miss Luckes at the London to ask for a 
head for her training school, the Swedish Sister 
having gone. Miss Luckes evidently had not realised 
that destiny intended Miss Elston for the French 
nursing revolution, for she had replied that she had 
no one to send. Three weeks after receiving a per- 
sonal offer from Dr. Hamilton to take charge of the 
school, Miss Elston was in Bordeaux. 

The career of unbroken success and brilliant 
achievement that fell thereafter to her lot, graciously 
and most modestly met as it was, should be a source 
of pride and satisfaction to her alma mater. It 
would have been hard to find anyone better adapted 
for the work in hand. By birth and environment a 



3io A History of Nursing 

well-bred and cultured lady, of charming personality, 
at once winning and dignified, with no little sense of 
fun and humour combined with an excellent discre- 
tion, a very able executive and a gifted teacher, 
cherishing independence of thought and freedom of 
will without egotism, she has in appearance and 
manner as much that is French as English, and this 
happy combination makes her an ideal leader for the 
young gentlewomen who come to enter the new pro- 
fession. Within the brief span of three years' time 
the entire order of work and teaching in the Pro- 
testant nursing school was transformed, and brought 
to as high a level as that found in any country, for 
not only do the Bordeaux schools show a complete 
grading and rotation of services, giving the nurses 
special as well as general branches of nursing, but the 
theoretical programme has been elaborated to un- 
usual harmony and fitness. Miss Elston, however, 
was allowed to remain with Dr. Hamilton only long 
enough to train her successor. 

The course of events now brings us to one of the 
medical fraternity who, among all those who have 
interested themselves in nursing progress, holds a 
place at the very forefront for what he did, and 
merits a unique regard for the way he did it. Dr. 
P. L. Lande, of Bordeaux, was a very determined 
and very liberal man, who wielded much power 
and influence. At the time of writing he occupied 
the chair of Medico-Legal Jurisprudence in the 
University of Bordeaux, was the Medico-Legal Jurist 
for Southern France, a member of the National 
Council of Public Charities, and a member of the 
Administrative Committee of the Civil Hospitals of 





Catherine Elston 
Directress of the Tondu Hospital and Nursing School, Bordeaux 




Revolution in French Hospitals 311 

Bordeaux. Recently decorated with the Cravate du 
Commandeur of the Legion of Honour, a distinction 
bearing witness to distinguished public services, he 
was weighty in public councils and genial in private 
life. 

At the time Dr. Hamilton was initiating her work 
at the Protestant Hospital, Dr. Lande was the Mayor 
of Bordeaux, and on one fortunate day he was taken 
to see the new wonders there by Mme. Kriegk, a 
friend of Dr. Hamilton's, a brilliant, intellectual 
feministe full of ardent sympathy with social-reform 
movements. Impressed and delighted by what he 
saw, Dr. Lande determined to introduce the same 
system into the public hospitals. Many were the 
discussions that followed. The little group of 
friends talked over every possible way of beginning 
and it was decided to try the experiment in the large 
hospital of Saint Andre, holding a thousand beds, 
where three of the twenty-two wards should be 
selected as an experimental field. The hospital was 
already staffed by Sisters of two different orders, that 
of Nevers and Saint Vincent de Paul, the more 
menial parts of the ward work being performed by 
attendants, while the more strictly nursing duties 
fell to young medical internes. It was decided that 
the new training should be open alike to the nuns and 
to the secular staff of this and of other hospitals, no 
distinction of religion being made. It was thought 
best that a Dutch nurse should be chosen as the 
head, for traditional hostility toward the English 
still smouldered, so, though Miss Elston would have 
been glad to try the experiment, Dr. Lande and 
one of the city officials went off to Holland and 



312 A History of Nursing 

brought back a Matron who had been highly recom- 
mended by a physician, but who proved to be 
unequal to the extraordinary amount of adaptation 
needed. After three months she gave up the strug- 
gle and the Protestant Hospital then came nobly to 
the rescue, by lending Miss Elston to continue the 
trial. 

It may be imagined what she found confronting her 
when, in April, 1904, she entered St. Andre, with its 
incompatible mixture of elements, authorities, pur- 
poses, and prejudices. The resident medical students 
were furious at the oncoming of a school for nurses. 
They had written a pamphlet of fifteen pages, declar- 
ing that all a nurse needed was to be clean and 
intelligent; all the rest was in the doctor's province. 
' Is a school needed to produce such nurses? No. 
Any intelligent and zealous young man (medical 
student) can gain easily and quickly, under the 
direction of an elder comrade, and with the instruc- 
tion of the chief of staff and the house men, the 
knowledge necessary for the care given to the sick. ' 
The young men contended that the nurses would 
surely go into private duty in the town, taking this 
also away from the students of medicine, and that 
they would also as surely practise medicine unlaw- 
fully. The male secular attendants at St. Andre 
wrote a badly spelled, menacing letter to Dr. Hamil- 
ton, threatening her with vengeance, and obscene 
articles were published in the public press. The 
Sisters naturally enough could feel no sympathy with 
the new regime, yet many of them absorbed a good 
deal of the practical teaching, and their own nursing 
improved materially in many instances. 



Revolution in French Hospitals 313 

The diary of one of the nurses gives a lively ac- 
count of the opening days : 

At two o'clock in the afternoon the Prefct of the 
Girondc, M. Lutaud, accompanied by M. Landc, Mayor 
of Bordeaux, and the members of the hospitals committee 
came to inaugurate the nursing school in one of the 
women's wards of Saint Andre. In his short address of 
encouragement, he said he would uphold the school at 
all costs: 'Je soutiendrai /' Ecole envers et contre tout.' 
This is now the motto of the school. 

The ceremony quickly over, the assembly disperses 
and we begin work. There are three cheftaines (head- 
nurses) and seven probationers, two of whom know some- 
thing of hospital patients ; the others had never set foot 
in a hospital. A cheftaine and two probationers are to 
go on night duty; our ward of thirty-eight beds, called 
Salle Premiere, is allotted to two surgeons, both of 
whom are opposed to the introduction of lay nurses. The 
patients, after the first curious interest is over, begin to 
sob and moan. Who knows what they had heard of us? 
We begin by putting the ward tidy; the cheftaines in- 
spect their new services ; the evening dressings and treat- 
ments begin; we want some boiled water no signs of 
any nor means of preparing it; the ward maid explains 
that it must be fetched from behind the pharmacy, 
which is five minutes away along endless corridors and 
passages. A pupil goes for it with a huge enamel jug, 
but on her return the jug is empty; it has a hole in it. 
At last we get some boiled water and begin the work. 
New disasters; in giving the douches all the beds are 
found sopping; the douche tins leak. About four 
o'clock we see water running from the bathroom into the 
ward ; on examination we find the overflows plugged with 
wool. At five o'clock we are trying to wrestle with the 



314 A History of Nursing 

dinner, when the ward maid announces her departure. 
She goes and is not replaced. But we do not lose heart. 
We manage to get the washing-up done, although to our 
horror we discover the new pupils washing sputum cups 
and tea-cups together. The ward swept and more or 
less in order (principally less), we give over the patients 
to the night nurses. The pupils go home, scared and 
dispirited. 

The next day we go on duty at six- thirty. The chef- 
taine has a few surprises about the linen. Yesterday 
the linen cupboard was well filled and seemed very tidy ; 
but when the piles of clean shirts, distributed among the 
patients are opened, they are all found to be in rags. 
Everything is in the same condition. While the nurses 
are making the beds we hear many unpleasant remarks, 
comparing us very unfavourably with the nuns. Several 
of the beds are wet and the mattresses have to be changed. 
We are at a loss to account for this accident, unusual 
in a surgical ward, but later, when the patients become 
friendly they confess to us that they had emptied their 
hot-water bottles into the beds, thinking that the mat- 
tresses would not be changed and that the nurses would 
be discredited in the eyes of the doctors. 

At 8.30 come doctors' rounds. The drawbacks we had 
met had belated us. The temperatures are not even taken. 
The night before we had quite forgotten them, but in the 
morning, when the cheftaine went to her dressing closet 
she found only a row of empty cases. The new staff had 
never been present at rounds. No one knew the doctor's 
ways. There are practically no dressing bowls; the 
drugs and instruments which they expected to use have 
''vanished." The few instruments at hand are out of 
date or broken. When rounds begin all the students 
from the whole hospital meet in our wards to see "Les 
Bleues" [the nurses wore blue uniforms]. The confusion 
is indescribable. We have literally to fight our way to 



Revolution in French Hospitals 315 

the doctors. The next day is better, as the administra- 
tion puts up a notice forbidding all except those belonging 
to the ward to enter it. All sorts of vexatious rules are 
made for the lay nurses. . . . After a little, things begin 
to improve. 

In the Protestant Hospital Miss Elston's place 
was taken by Mile. Larimanou, one of the gradu- 
ates, and from that time a nurse of the school has 
held the position. For six months Miss Elston kept 
her footing, and in October, 1904, the Prefet came 
to her and asked if she felt capable of managing a 
hospital alone? She said, "Yes, if she could have 
it under her control. ' She was then transferred, 
with a staff of nurses, mostly from the Protestant, 
to the Tondu, a city hospital of some 120 beds, where 
she soon had a model system established. x Back of 
this success was the solid strength of Doctor Lande. 

The hospitals, like the public schools, were foot- 

1 The administrative committee of the hospitals voted five to four 
for the creation of the secular training school. In the affirmative 
were MM. Lande, Preller, Dupeux, Dubosc, and Lauga. Against 
it were MM. Daney, Lanusse, Faure, and Magne. M. Daney 
brought his objections carefully written out, to be inserted in the 
minutes. They were under four heads, the first three being of 
negligible import; the fourth read as follows: "The organisation of 
the new personnel of the proposed school, in placing under the 
authority of the Directress head nurses and certificated ward nurses, 
who, having completed their studies, no longer belong to the school, 
is an innovation dangerous to administrative order, and is, as M. 
Sabran with his eminent authority has declared, an organisation 
incompatible with the rules regulating public institutions, and can 
lead only to a fatal confusion of powers. " 

After the decision became known, a meeting of the medical and 
surgical men of the city was held, at which time, says a Bordeaux 
paper of that date, a unanimous vote of protest against the proposed 
school was passed. 



3i6 A History of Nursing 

balls in the game of political strife, and feeling ran so 
high that he lost his re-election as mayor of Bordeaux, 
but still, quite quietly and with few words, he has 
continued to use his influence to put trained women 
where they belong, and to secure for them the neces- 
sary footing. It is in this that he is unique, and he 
deserves, for his frankly Jeministe attitude, the high 
esteem and gratitude of the nursing profession he has 
done so much to foster. He has written very dis- 
criminatingly of nursing, and with weight, often 
entering the lists when some public controversy over 
hospital questions was going on. In the Journal de 
Medecine of Bordeaux (23 Oct., 1904), he said: 

It is through Mile. Hamilton that I came to appreci- 
ate thoroughly the urgent necessity of a transformation 
in the secondary personnel [the nurses] of hospitals. I 
am glad to offer her this recognition. To her belongs 
the credit of having pointed out the imperfections of 
reforms attempted in our country since 1882 and of 
having proved that it is easy to obtain, in France, re- 
sults comparable to those which she holds up as 
examples. 

The schools of the Protestant and the Tondu 
hospitals are, in general outlines, so alike, that they 
can be described together. They are both quite 
ideal in their atmosphere of earnest aspiration and 
sincerity. In refined and home-like surroundings, a 
sweet and cheerful spirit reigns, and the young 
women who present themselves are of a high order, 
educated, gracious, and competent. The Protestant 
Hospital accents the educational character of train- 
ing by charging its pupils tuition fees, and by taking 



Revolution in French Hospitals 317 

day scholars who live in the city. The hours, duties, 
and responsibilities of the day scholars, however, are 
precisely the same as those of the residents, including 
night duty. The Tondu, being a public hospital, 
requires in lieu of tuition fees either a contract for 
two additional years' service after training, or the 
payment of a sum representing the cost of the pupil's 
living expenses in the hospital. Both schools are 
exceptionally admirable in the careful thoroughness 
of the training. In each one every department of the 
hospital is utilised as a practice field and the pupils 
pass through the housekeeping and administrat- 
ive departments, learning every branch of hospital 
management by actual doing. Each has a trained 

s 

housekeeper or '"Econome" whose position is equal 
to that of the head-nurses, and part of her duty is to 
give the pupils a practical service in buying, account- 
ing, and general management, including dietaries. 
Dr. Hamilton is what we call superintendent of the 
hospital, responsible to the trustees, and is the only 
resident medical officer. Miss Elston's position is 
like that of the English Matron. She is the chief 
resident officer, directing the whole housekeeping and 
general internal management of the hospital as well 
as being principal of the training school, but certain 
parts of hospital administration on the business side 
are carried on by non-resident officials, the secretary, 
comptroller, and econome, with whom she is expected 
to co-operate, as also of course, with the medical staff. 
The head-nurses are called cheftaines; the directress 
of nurses at the Protestant the Cheftaine Generale. 
The word is Old French, and was discovered by Dr. 
Hamilton in ancient documents. It had been quite 



318 A History of Nursing 

forgotten, and when she revived it, it drew forth quite 
a little indignation, as it was supposed to be an Eng- 
lish title. There are a certain number of permanent 
nurses, and the pupils' course covers two years. No 
private duty for under-graduates is allowed. The 
uniform is very attractive: a clear blue linen, with 
full white shoulder-strapped aprons, cap, and white 
collar and cuffs. Graduates wear a blue and white 
brassard with the device of the school. Nurses are 
not permitted to go out in their linen dresses, but 
a neat and pretty street uniform is optional. 

The hospital routine gives the pupils eight hours 
of day and twelve of night duty, the latter being 
arranged in periods of two weeks at a time. The 
day duty, beginning at 7.30 in the morning, is over 
by the same evening hour, and the contrast in ef- 
ficiency with the mediaeval system of hours as we 
have seen them under the rules of the religious orders, 
beginning with four A.M. and lasting until ten P.M., 
is indescribable. The requirements for entrance are 
similar to those of the best schools everywhere, and 
the course of study is much like our own. At the 
end of the two years' course the pupil, having passed 
her examinations successfully, is free to leave the 
hospital and to take up any line of work that appeals 
to her. 

The vitality of a movement is proved by its spread. 
From the outset Dr. Hamilton set the regeneration 
of hospitals to the forefront, and she has ever held 
this ideal before her nurses, encouraging them, as 'did 
Miss Nightingale with the first English nurses, to go 
into reform work. 

She and Miss Elston, effectively supported by Dr. 



Revolution in French Hospitals 319 

Lande, who lost no opportunity of throwing his 
strength upon strategic points, have generaled a 
remarkable series of invasions of large provincial 
hospitals, and the "Blue Nurses" of Bordeaux are 
doing for France the work that the "Nightingales" 
did for Great Britain in the early sixties and seven- 
ties. Like them they are sent preferably in groups 
to undertake the task of remodelling some old hospi- 
tal, but Dr. Hamilton will not allow them to go at all 
unless the administration first agrees to give one of 
them the position of directress of the hospital, for, if 
they were simply to be put in as head-nurses or 
supervisors under a director accustomed to the old 
system, they would be powerless to effect reforms in 
the nursing. 

In 1900, while she was still at work on her thesis, 
Dr. Hamilton had persuaded Mile. Luigi of Mont- 
pellier, a clever and gracious young Frenchwoman of 
good family, to take the nurses' training, and she had 
gone to the London Hospital for four years. In 1903 
the Mayor of Beziers having applied to Dr. Hamilton 
for a staff of nurses for the hospital of that city, she 
advised him to secure Mile. Luigi and to train his 
own. He took her advice, Mile. Luigi went to 
Beziers immediately upon her graduation, and 
founded a training school there under most pictur- 
esque and varied difficulties. She arrived in January, 
1905, to find an extensive and rambling hospital of 
nearly four hundred beds, including a maternity, mil- 
itary wards, and contagious services. It had been 
laicised a year before, and the whole place was in the 
most dire confusion. The maternity was absolutely 
devoid of any equipment even of the simplest kind, 



320 A History of Nursing 

* 

save beds and chairs. Deliveries were conducted 
by a dame of sixty, the patients sitting in a large arm- 
chair to be confined and afterwards walking to their 
beds. Everything else was on a par with this. 
Water for the smallpox patients' baths had to be 
carried a quarter of a mile in buckets, and in the 
midst of everything else military rounds and inspec- 
tion, formal and brilliant, took place at a morning 
hour not long after the dawn. The general-in- 
chief, it is said, suffered a severe shock on beholding 
for the first time, at rounds, a Matron of twenty- 
four in blue linen and white cap, to whom his in- 
valided soldiers were to be confided for care and 
discipline. He believed they would not obey her 
orders, but, needless to say, they did. 

After some six years' work there, Mile. Luigi took 
charge of the Hotel-Dieu in Rheims, an even more 
difficult problem. 

In rapid succession nurses from Bordeaux have 
been drafted into the municipal or provincial hospi- 
tals of Albi, Alais, Castelnau-du-Medoc, Cambrai, 
Elbeuf, Dijon, Lorient, Constantine, Pau, Pauillac, 
Tunis, St. Questin, Rueil, Issoire, and other towns. 
Dr. Hamilton writes: 

You would indeed be interested if you knew all the 
details of those hospitals where our nurses have gone to 
work, and every day I realise more how important is 
the good practical training in the wards. What most 
surprises the doctors (all more or less prejudiced against 
lady nurses) is the fact that they do for the patients so 
many things the nuns would object to do, and that 
they do not discuss and meddle with the doctor's 
orders. 



Revolution in French Hospitals 321 

The transition at Albi was especially dramatic, as 
the nuns left the hospital at twelve o'clock, while the 
nurses entered it an hour later. Three hundred 
patients here awaited Mile. Nectoux, a serene, 
capable, and not easily daunted directress, who 
came with a group of head-nurses in the midst of an 
epidemic of scarlet fever and measles. They soon 
learned, as they said, "to lose the sleep habit" while 
preserving their gaiety and energy. A strong sense 
of social responsibility was ingrained in these fine 
young women. It is no light matter to be sent to 
substitute for the members of a nursing system that 
had lasted some fifteen hundred years and had, 
during the long centuries, stood for the pattern of 
self-sacrificing devotion in the eyes of the world. 
The new nurses felt this, and took their position 
seriously. 

Long after they had quelled the scarlet-fever out- 
break, a poster still hung on the doors of the Cathe- 
dral, protesting against the laicisation of the hospital, 
calling it undemocratic, and adjuring the city council 
to grant :< social justice.' Yet it would seem that 
to teach women their work and pay them for doing 
it is neither undemocratic nor unjust. 

It would be impossible in one short volume to 
follow the nurses in all their pioneering, but a few 
extracts from letters will suggest their experiences. 

(From a hospital of 150 beds) ; May, 1905: 
I would like to describe the first day we spent here, but 
it defies description. The concierge, nurses, servants 
in short, the entire personnel of the hospital entered the 
place for the first time. The econome was the sole 
member of the former staff who remained. When we 

VOL. III. 21 



322 A History of Nursing 

reached the hospital at five o'clock in the morning, he 
gave me a large box of keys heaped pell-mell with no 
tags to them, and I spent the day running from one place 
to another trying to find the right keys for the keyholes. 
He had no idea at all of how things had been run, as he 
had left everything to the Superior, and did not even 
know where the sugar was kept. Finally the sick re- 
ceived the care they needed, and fortunately all demon- 
stration outside was, by good management, avoided. 
I knew that the captain of the gendarmerie had tele- 
graphed for reinforcements and we were told that 
soldiers patrolled all the approaches to the hospital. 

A Bordeaux nurse, who had been placed in charge 
of a male division with sixty beds in a laicised hospi- 
tal, wrote in 1906: 

The ward for a time had been left to the care of a 
young male servant, and the patients did exactly as they 
pleased. They smoked, morning, noon, and night, and 
I have seen one cooking an omelet on his bed. The 
young woman who for three years had been head-nurse 
of this ward was on terms of great familiarity with the 
patients, and at nine o'clock she was accustomed to 
seat herself with her crotcheting beside her favourite, 
a chronic case who was her servant, man of affairs, and 
confidant, and who had a whole outfit of domestic utensils 
in his bed. He cleaned and mended her clothes, filled 
her lamp, waxed her shoes, polished the instruments, 
broke up loaf sugar, cut and made dressings and bandages, 
without ever getting out of bed or washing his hands, 

In another place the nurses found the main drain 
packed for a distance of forty feet with old shoes, 
pans, bottles, broomsticks, and aprons, as a protest 
against their coming. 



Revolution in French Hospitals 323 

Among all that have been laicised the hospital of 
Elbeuf has enjoyed unbroken harmony from the 
outset. It is a large one of 600 beds, its history 
running back to before 1330, and has been under the 
care of Ursuline nuns, first, and later of Sisters of St. 
Vincent de Paul. In September, 1907, a band from 
the Tondu went into it, and the Directrice, Mile. 
Gonthier, by her tact succeeded in so harmonising 
all the political sections that ill-will was quickly 
changed to amiable co-operation. Soon after the 
new staff was installed the mayor of the city wrote 
an appreciative letter to Dr. Lande : 

You will wish to know something of the nurses; they 
have proved to be fully equal to their task and have 
uncomplainingly undertaken a crushing and uninter- 
rupted burden of work. Dr. Hamilton sent two more to 
help them, but we need ten rather than six head-nurses 
if they are not to be badly overworked. . . . The moral 
and professional qualities they have displayed have sur- 
passed my highest expectations. 

It did not take long for the news to get about that 
new and strange theories were being put into prac- 
tice in Bordeaux. A steady stream of visitors then 
turned thither, to investigate. Especially were sur- 
prise and curiosity awakened by the Tondu experi- 
ment, for it had been firmly believed that, while a 
hospital under private management might succeed 
in departing from old French nursing customs, this 
would be impossible for one under municipal rule. 
Yet in the Tondu was displayed to their astonished 
eyes a model nursing system established by the city 
administration. 



324 A History of Nursing 

The visitors' books at the Bordeaux schools con- 
tain the names of almost all the prominent men in 
public life, especially those in the administration 
of public charities (including hospitals) under the 
Department of the Interior. There came the Prefets 
from many districts; deputations from city govern- 
ments; officers of the French Medical Association 
and university professors ; statesmen especially inter- 
ested in philanthropy and social reform, such as 
Strauss and Riviere; political economists, such as 
Mabilleau ; a former governor-general of the colonies 
of Indo- China ; an inspector of charities from Algeria ; 
and Casimir Perier, an ex-President of the Republic. 
The King of Spain stopped one time on his way home 
and was taken all about by Dr. Lande. He expressed 
great pleasure at all he saw, complimented the nurses, 
and took a bunch of flowers to the Queen from Mile. 
Yparraguire, a young Spanish probationer. Finally, 
an important development was heralded by the 
appearance of emissaries from the Department of 
State and the War Office. M. Etienne, when Minis- 
ter of War, made rounds in the Tondu accompanied 
by the whole military staff of Bordeaux; General 
Picquart, when occupying the same office, appeared 
at Cambrai, where Mme. Gardiol from the Protestant 
Hospital was in charge ; one under-secretary of state 
descended upon Mile. Luigi at Beziers; another, 
Cheron, whose surprise visits of inspection became 
famous, came unheralded one evening in 1908 to the 
Tondu, and, accompanied only by Dr. Lande and 
Miss Elston, went into every nook and corner, cross- 
questioned the patients and nurses, who did not 
know who he was, got light on every detail from Miss 




Dr. Lande Lecturing to the Tondu Nurses 




Protestant Hospital Nurses Dressing the Christmas Tree 



Revolution in French Hospitals 325 

Elston, even looking into cupboards and bureau 
drawers, and flew away as swiftly as he had come. 
The War Department was on the eve of creating a 
staff of army nurses. 

The shortcomings of army nursing were many, for, 
after the nuns had gone, their places were taken by 
orderlies. In 1907, the army medical paper Caducee 
voiced the demand for skilled nursing and has contin- 
ued an energetic propaganda. In 1 908, the announce- 
ment was made that a competitive examination was 
to be held for the admission of nurses to the army 
nursing staff. It took place in April, 1908, and, of 
421 candidates who came forward from all parts of 
France to take it, three Bordeaux nurses, Miles. 
Chaumont, Labadie, and Teyssiere, passed first, 
two of whom received the first army appointments 
that were made. Dr. Hamilton wrote : 

Miss Elston and I went to the examination, and we 
were much amused to see how pleased the military doc- 
tors seemed at the good practical knowledge of our 
nurses. In the morning they had a written examination 
and in the afternoon it was oral and practical. The 
nurses appeared in their blue dresses and caps, which 
seemed to please the officers very much. They had 
probably never seen nurses in uniform. 

After some delay and waiting for Parliament to pass 
an appropriation, the nurses were finally offered their 
choice of posts, and the twenty-nine successful ones 
were placed in the military hospitals on January i, 
1909. Our space forbids going into more detail on 
the army nursing service and the preliminary skir- 
mishes with the Red Cross societies, whose influential 



326 A History of Nursing 

members desired to obtain the prestige of first place 
in military hospitals for their lady amateurs. The 
events as they occurred were fully and ably dealt 
with by La Garde-Malade Hospitaller e for 1908, 
whose editorials did much to shape constructive 
action. The Boer War had thrown light on the 
relative value of amateur versus trained nursing 
methods, and a number of French physicians added 
their voices to the demand for well-trained nurses in 
the army, referring back to the warnings given by 
that experience. Dr. Hamilton, always on the alert 
to plant a timely idea, had, shortly after the war, 
written to the International Committee of the Red 
Cross at Geneva, to suggest 

That, upon the initiative of the international com- 
mittee, every central (national) society of the Red Cross 
should be called upon to state whether, in their countries, 
they possessed organisations analogous to the English 
Army Nursing Reserve service that is to say, of nurses 
of superior education who in time of peace are in daily 
and nightly charge of the sick, to the exclusion of all 
other nursing bodies, and who, in time of war, are entirely 
at the disposition of the military authorities. (Bulletin 
International des Societes de la Croix-Rouge, 1901, p. 40.) 

No answer came to this letter. 

At present the French army service, still in its 
formative stages, gives ground for criticism and 
admonition. It has no woman placed at the head 
of the nursing service, and no grading in the wards. 
It has decreed an ugly and insanitary uniform, and 
still contemplates the admission of married women, 
making provision for their family cares with all the 



Revolution in French Hospitals 327 

matter-of-fact forethought of the civil hospitals. 
But it may safely be left to the influence of time, the 
management of the Bordeaux nurses, Dr. Lande's 
advice, and Dr. Hamilton's trenchant and ready 
pen, to amend all defects. Miss Elston wrote in 
1909: 

The position of army nurses is not well defined ; they 
have the special care of serious cases, help the orderlies in 
distributing food and drugs, and attend rounds. They 
are under the authority of the physician in charge. The 
provisional rules do not mention their rank, but in the 
matter of rations they are treated as non-commissioned 
officers. They are included in the list of the staff for 
active service, but their duties are not defined. The 
army nurses have one year's probation, and at the end 
of this, if satisfactory, they are taken on the regular staff. 

A second examination took place in September, 1909, 
the Tondu sending up twelve, all of whom passed 
among the first fifty. 

In 1909 the Bordeaux nurses had a new opportun- 
ity of proving their merit. An alarming epidemic of 
typhoid broke out in the army garrison of Saint- 
Brieuc, and several of the nurses were called to give 
it battle. They covered themselves with glory by 
their mastery of the situation, and the French Gov- 
ernment, always quick to show appreciation, gave 
medals to two of the nurses for their meritorious 
services. 

In May, 1908, the first visiting nurse appeared in 
the Bordeaux galaxy. The money wherewith to 
support her had been given to Dr. Hamilton by 
relatives, Commandant and Mme. Pilate, in mem- 



328 A History of Nursing 

ory of their only son, who had died in a military 
hospital from a gunshot wound, and whose sufferings 
had been greatly increased by bad nursing. Dr. 
Hamilton wrote: 'This sum, sent to 'relieve those 
who suffer,' came at a moment when the necessity 
of having a nurse to visit the sick poor had made 
itself felt with special force at the Protestant Hospi- 
tal. ' The first nurse appointed was Mile. Amory, 
one of the Protestant graduates, and the work has 
been carried on with the most signal success as an 
extension of the dispensary service of the hospital. 
From the first it has been made a combination of 
good nursing with that friendly care for the uplift 
of the individuals and families which has come to 
be known as social service, and economic and indus- 
trial conditions have been faithfully recorded in the 
nurse's note-book along with the nursing notes. 

In January, 1912, through the persistent efforts of 
Dr. Lande, the first public school nurse in Bordeaux 
was placed under the city government, to make a 
demonstration of her usefulness. Mile. Rolland was 
entrusted with the care of 2000 children in the 
largest public schools in a crowded quarter and Dr. 
Lande undertook to relieve the administration of the 
cost of the experiment. 

In October, 1906, the journal of the Bordeaux 
nurses and their branches was founded. It appears 
monthly in a blue cover and is called La Garde-Malade 
Hospitaller e (La Neurse Frangaise), with the sub-title 
Organe des Ecoles de Gardes-Malades, Systeme Florence 
Nightingale. Animated controversies have arisen 
over Dr. Hamilton's bold introduction of a new word 
into the French language, some regarding "Neurse" 



Revolution in French Hospitals 329 

as an abomination, while others accept it as a neces- 
sity, a new word for a new thing. The journal 
had an editorial committee of Dr. Hamilton and 
five nurses, including Miss Elston, an advisory com- 
mittee of Dr. Lande and Dr. Regnault, and the pub- 
lishing details are assumed as a labour of love by 
Mme. Kriegk. It is fearlessly militant and critical, 
watching the whole French nursing field and bringing 
testimony from all over the world in support of its 
standards. 

In Bordeaux centres a Society of Hospital Direc- 
tresses from which a national nursing organisation 
will doubtless proceed in time. 

In April, 1912, Dr. Lande was stricken down by 
paralysis whilst presiding at the meetings of the 
General Medical Association, and died two days 
afterwards a blow which stunned the progressives 
of all lines and inflicted upon nurses an irreparable 
loss. 

From the successful demonstration of the Nightin- 
gale system in Bordeaux, we now turn back to the 
great public hospitals of France, and especially those 
in Paris. Before the first municipal training schools 
had been opened in 1877, the relative numbers of the 
nursing staff in the Paris hospitals 2353 secular 
attendants to 502 religious Sisters showed how 
much of the care of the sick was actually in the hands 
of the servants of the administration and how 
undeniable was its obligation to them. But for a 
long time hospital authorities thought more of con- 
trol than of obligations. Dr. Bourneville told pub- 
licly one time, how hostile administrations had put 
every possible obstacle in his way; how directors 



330 A History of Nursing 

were appointed to the hospitals who were openly 
unfriendly, not indeed to laicisation, but to the 
courses of instruction or to any professional teaching ; 
of how the professors were hampered by finding the 
head-nurse teachers arbitrarily changed in the middle 
of the term, and how they had to endure the " bitter 
derision" of having head-nurses given them to teach 
classes who had never themselves been taught. 
Many hospital directors openly declared the expense 
of the courses unnecessary and useless. 1 The rota- 
tion in service which he had always demanded he had 
never been able to obtain. 

But progress in public sentiment was evident 
when the Congres Internationale & Assistance, meeting 
in Paris in 1889, after hearing from Dr. Bourneville 
a history of his effort to teach nurses, passed an 
excellent set of resolutions urging better teaching, and 
an improved economic, moral, and social status for 
them. These resolutions were sent to the Minister 
of the Interior. The Conseil Superieure de V Assis- 
tance publique, the national department of public 
charities, next took up the question. In 1898, Dr. 
Napias made a report to this influential body, in 
which he urged the creation of schools for nurses 
throughout France, and suggested the appointment 
of a special committee to prepare a programme of 
theoretical instruction. The committee appointed, 
Drs. Letulle and Faivre presented it with a pro- 
gramme differing little from that of the municipal 
schools. Their material, somewhat elaborated by 

1 Congres Internationale d f Assistance publique et de Bienfaisance 
privee, Paris, 1900. Enseignement professionel du personnel second- 
dire des hopitaux, vol. iii.-iv. 



Revolution in French Hospitals 331 

the committee, was adopted and promulgated, in 
1899, as a part of the Circular on Nursing of M. 
Henri Monod, then president of the Conseil Su- 
pcrieure de V Assistance publique. 

This weighty recommendation, coming from the 
highest authority in the land, committed the French 
Government definitely to the principle of educating 
its nurses; the only debatable point remaining was, 
what method to use. It was the year before Dr. 
Hamilton made her first appearance in public. There 
was no one to bring forward Miss Nightingale's 
principles. The directors had full power over the 
nursing staffs; the doctors knew that they wanted 
efficient nurses but did not understand the methods 
by which to attain their end. Of this, however, they 
were unaware, and theoretical instruction adminis- 
tered by brilliant men to young people of the working 
classes was accepted as the way to bring on a nursing 
millennium. The phrase " lecture courses'' became 
a sort of magic formula. Several towns responded 
to the ministerial circulars by establishing or trying 
to establish the miracle-working courses. Quite 
naturally they failed of effect. In Rheims, Alger, 
Lille, and Aix, it was admitted that the schools of 
instruction had been unsatisfactory. M. Sabran 
introduced the courses into the hospitals of Lyon, 
and maintained that they were successful. The 
kind of nursing that prevailed was, however, not 
altered. In 1902 another circular was sent out by 
M. Combes. 

But now Dr. Hamilton was at hand to urge the 
claims of the Nightingale system with all the trench- 
ancy of Miss Nightingale herself. It was not a little 



332 A History of Nursing 

annoying to prominent and weighty officials to hear 
this daring woman tell them that their methods were 
obsolete and their results failures. Her potent 
w r eapon, the pen, is a sword that is never sheathed. 
No misrepresentation is allowed to pass; no mis- 
statement escapes her; no slipshod nursing method 
goes unchallenged. Keen in logic, exact in state- 
ment, always armed with documentary evidence, 
giving neither praise nor blame except as the service 
of truth as she sees it demands, she had many a tilt 
with the powers that be. The liveliest skirmish on 
this line took place at the Third National Congress 
of Public and Private Charities, at Bordeaux, in 
1903. On this occasion several of the most impor- 
tant of hospital directors and physicians read papers 
upon the training of the nurse, and Dr. Anna Hamil- 
ton appeared to smite them hip and thigh. "After 
an experience of twenty -five years" she began, 'we 
are able to assert positively that professional instruc- 
tion alone has not improved the quality of hospital 
nursing. " She closed her paper with a summing up 
of points, each one of which was a direct blow to the 
laborious conclusions of the others : 

1. Good results in training nurses can be obtained 
only by selecting women of culture. 

2. The professional education of a nurse cannot be 
given by lectures only ; it consists pre-eminentlyof training 
in hospital wards, where, under the direction of skilled 
head-nurses, the pupils perform the entire task of nurs- 
ing while passing regularly from one service to another. 

3. Theoretic instruction should be simple and should 
accompany practice. 

4. The diploma should not be granted for theoretic 



Revolution in French Hospitals 333 

examination only, but should recognise the practical 
work. 

5. The nursing staff, permanent head-nurses as well 
as pupils, must be placed under the exclusive authority 
of a woman, herself a trained nurse, and endowed with 
the powers necessary to secure respect for the staff in 
her charge. 

In the discussion M. Sabran said: 

I share Dr. Hamilton's belief that a trained woman, 
a directress, should be placed over the pupils in the 
school; but I cannot agree that she should have any 
authority whatsoever outside of it; still less can I con- 
ceive of her having authority over the head-nurses in 
the wards, as Dr. Hamilton desires she shall have. 

Dr. Felix Regnault, who is on the progressive side, 
wrote a lively account of this meeting to a medical 
journal: 

. . . Shall we indeed confide our instruction to capable 
head-nurses and give the entire control of the pupils into 
the hands of a directress, a matron, as she is called in 
England? Never will our administrators consent to 
yield such powers. They are too fearful of weakening 
their authority. "There would be nothing left for us 
to do but to resign, " said one, and by no means the least 
prominent. No, we will continue with half-way meas- 
ures ; we will retain the chef du personnel [a sort of boss or 
foreman of the nursing staff], the worthy representative 
of an administration which exercises the historic right 
of cuissage over its subordinates. . . . x 

Finally a decisive step forward was taken. An 
official document says: "The regulations of the first 

l Le Correspondant Medical, July 31, 1903. 



334 A History of Nursing 

of May, 1903, elaborating the details of a general 
reform of the nursing service [of Paris] drew a line 
of distinction between the nursing staff and ward 
maids by creating a recruiting centre destined to 
prepare hospital nurses. " J 

The government thus advanced in the right direc- 
tion. M. Montreuil, then Director of the Salpet- 
riere, was sent to England to report on hospital 
nursing, which he did with understanding. This 
scholarly, old-school gentleman was deeply sym- 
pathetic with the modern nursing movement. Pos- 
sessed of a rich and mellow culture, he held frankly 
progressive views as to the work and place of women. 
It was a real loss to the cause that his retirement 
on pension should have come just at the opening of 
the new era, and those nurses who were privileged to 
know him will not forget his kind liberality of opinion. 

When M. G. Mesureur became Director-General 
of the Paris Department of Public Charities, he found 
among his predecessor's notes plans and estimates 
for a School for Nurses. He determined to complete 
it, and thereafter the improvement of the nursing 
service was one of his cherished objects. A kindly 
and tactful official, sincerely desirous of elevating the 
morale and technique of nursing in the hospitals, he 
has erected a splendid memorial of his administra- 
tion in the new school and its high purpose. In the 
summer of 1907, the finished structure stood exten- 
sive and beautiful, built upon a plan of great dignity 
and seemliness, in the ample grounds of the Salpet- 

s 

1 La Reforme du Personnel Hospitalise, 1903-1909. Ecole des 
Infirmieres de /' Assistance publique de Paris, 1909. Berger-Lev- 
rault et Cie., Paris. 



Revolution in French Hospitals 335 

riere. Its noble dining halls and spacious assembly 
rooms, fine amphitheatre for lectures and demon- 
strations, large class-rooms and small quiet studies, 
generously planned library and museum of nursing 
appliances and equipment, are like those of a college, 
setting it in the forefront of nursing schools, while 
provision was made for single bedrooms and every 
possible comfort for 150 pupil nurses, and for a 
Directress, the Principal of the school. Here is the 
outfit for a revolution. 

To realise how vast is the task before this school, 
let us, before its first pupils enter, turn to look at -the 
hospital system of Paris. It comprises general and 
special acute hospitals, almshouses with beds for 
chronics, special hospitals for children, insane, and 
epileptics, contagious cases, and obstetrics. Com- 
pleting the whole is a chain of convalescent homes, 
beautiful and well-managed, and providing enough 
beds for all the free patients of Paris, men, women, 
and children, who are transferred there from the 
hospitals before being finally given over to "follow- 
up care" in their homes or in the hands of charitable 
societies. In all, there are some sixty or more insti- 
tutions, with, roughly estimated, about 30,000 beds 
and a staff of some 8000 nurses and attendants, all 
controlled by the Department of Public Charities. 

The administration is highly centralised, and in 
economy and uniformity has many admirable fea- 
tures, especially in housekeeping and bookkeeping. 
Purchasing is uniform, and vast central storehouses 
receive and distribute supplies. But there are lines 
where this centralisation is too rigid. It is almost 
impossible to do anything in a new way, and initia- 



336 A History of Nursing 

tive is suppressed. Strangely enough, however, the 
nursing remains outside of this orderly plan. There 
is no nursing department; above and over all the 
nurses is no one woman. Within the hospitals, many 
of which receive one and two thousand patients, 
there is no woman superintendent. All supervising 
and head-nurses are directly responsible to the hospi- 
tal director, who delegates the oversight of details 
to a male official called the chief of nurses. The 
incoming nurses, who cannot be called probationers, 
as they are engaged on a different basis, are selected, 
assigned to duty, disciplined, dismissed, or retained 
by men. Besides the grievances of which we have 
heard, there is another which even Dr. Bourneville 
overlooked they are badly overworked. The wards 
are understaffed. Where English hospitals would 
have a head-nurse with six assistants, the Paris wards 
have two, or at most three, women to do everything. 
Probably nowhere in the world can a more cheer- 
fully hardworking, willing, and uncomplaining set 
of women be found than the infirmieres of the Paris 
hospitals, and, with the wonderful ability and 
exquisite manual dexterity of the Frenchwoman, 
they learn great skill and speed of action and pro- 
cedure but all the niceties and refinements of nurs- 
ing are lacking. The total absence of screens gives 
the keynote. Dr. Hamilton, with her usual fear- 
lessness, attacked the prevalent methods of hospitals 
in an article from which the following extract is 
quoted : 

It is a positive fact that in the hospital the patient is 
entirely deprived of moral protection, no matter whether 



Revolution in French Hospitals 337 

the hospital has been laicised or not ; he is considered as a 
non-human being absolutely subject to the needs of the 
medical students and at the mercy of the attendants; 
an indecency reigns there to which, because it is constant, 
all become finally oblivious except the patients, who, 
constantly changing as they are, are painfully surprised 
at the way they are treated. Is it necessary to have 
more money in order to remedy these things? Not at 
all ... to introduce truly competent women into hospital 
wards not only banishes all immorality, but contributes 
to the prosperity of the hospital, as the English examples 
show clearly . . . such women, distinguished and essenti- 
ally professional, are placed between the patients and the 
physicians; they surround the one with their constant 
solicitude and their moral protection; they give the 
others their intelligent help and often facilitate their 
difficult tasks. 1 

The most delicate and difficult problem of all lies 
in the unprotected state of the nurses, whose equip- 
ment of character is not always equal to self-defence. 
"The nursing staff is our harem"; said a young 
interne frankly one time, and in the novel written in 
1907 by M. Bru, the Director of Saint Antoine, one 
of the largest hospitals, called The Romance of a 
Hospital Nurse, the cold-blooded attitude of the 
young medico is taken for granted in the bald 
realism of the sordid tale. It is not evident that the 
literary director intended pressing any moral, nor 
does it appear that he is conscious of having brought 
a damning indictment against the unhindered rule of 
men over uneducated and undeveloped girls, never- 

1 Dans nos Hopitaux. By Dr. Anna Hamilton, in Le Signal, 
August 16, 1907. 



VOL. III. 22 



338 A History of Nursing 

theless his book is the strongest argument yet put 
forward for the need of Matrons in hospitals. 

Into this uncongenial environment comes the new 
school for nurses. In October, 1907, the first pro- 
bationers entered its doors. One must wonder that 
Dr. Hamilton, Miss Elston, and their capable gradu- 
ates were ignored in the organisation of this school, 
and yet, in the atmosphere of the Paris hospitals one 
may gather suggestions why this was so. They 
would insist on changes too radical. The lady first 
placed in charge as Principal, though of superior 
ability and character, was not a nurse, but held the 
diploma of a trained midwife. She had no represen- 
tatives in the wards where her pupils went daily for 
their practice in nursing, nor could she herself follow 
them about the hospitals. When the two years' 
training was over and the certificated nurses left the 
school, they were placed in vacancies wherever such 
occurred, and it was made plain that the internal 
arrangements of wards was not to be altered the 
old system was to be tried with a new type of nurse. x 
But so great a change as remaking the nursing of 
Paris must come slowly; when complete it will be 
tremendous. There will needs be a vast department 
of nursing, with the Principal of the School for 
Nurses at its head ; in each hospital a trained Direc- 
tress, and in the wards head-nurses, the most able 

1 The first report of the school (La Reforme du Personnel Hospi- 
taliere, 1903-1909. Ecole des Infirmieres de I' Assistance publique de 
Paris. Berger-Levrault et Cie., Paris, 1909) gives a detailed descrip- 
tion of the school, the plans adopted in the internal organisation, the 
reasons for every step taken, and the point of view of the administra- 
tion in shaping the whole. 



Revolution in French Hospitals 339 

graduates from the school. The Paris hospitals aim 
at keeping a permanent staff, so the seniors or staff 
nurses must also be chosen from those who have 
finished their course in the school. Under them will 
be trained the probationers, so that the same high 
level shall be maintained throughout. 

At the London Congress in 1909 the nurses of other 
nations had the pleasure of meeting a group of the 
pupils of the city of Paris, who were passing their 
interneship at St. Bartholomew's, and whose bright 
young faces, animated ways, and boundless enthusi- 
asm won all hearts. x 

One other foundation for training has been laid in 
Paris, also on private lines; a school whose inception 
came from Mme. Taine in 1904. It is established 
in a beautiful old convent and is directed with much 
ability by Mile. Chaptal, a woman whose great value 
as a citizen in many branches of social-reform work 
has made her widely known and respected. For a 
number of years this school, situated in the Rue 
Vercingetorix, sent its pupils into the wards of the 
public hospitals under the care of " monitresses. ' 
Mile. Chaptal, who had worked in a voluntary way 
in hospitals, knew well the importance of practical 
work, and from the beginning hers has been a serious 
experiment. After six years she is rewarded by the 
building of a private hospital of eighty beds in which 
her pupils will for the future be taught. Her school 
maintains a private duty home on the co-operative 

1 An interesting experiment with public school nursing was 
carried on for a time in 1908-9 by the pupils of the Paris training 
school, but as they were undergraduates we have considered the 
Bordeaux work as more definitive. 



340 



A History of Nursing 



plan, and she is able to select probationers of a highly 
desirable class. 

Our chapter began with the tragedy of the Augus- 
tinians ; but a renewal of life has come to the ancient 
order. In one of the most beautiful of the Paris 
hospitals, the Boucicaut, the terms of a philanthro- 
pist's endowment required that the Sisters of the 
Hotel-Dieu should be placed in charge of the wards, 
and though the hospital remains under the Assistance 
publigue the administration accepted the gift with 
this condition. The Sisters' hospital history is 
therefore not ended, and they have an opportunity 
to modernise their methods. It is of interest, too, to 
see that in the hospital of the Pasteur Institute nuns 
have been placed by similar request, for this hospital 
is solely governed by its own trustees. The order 
placed in charge was a branch of the Irish Sisters of 
Mercy. The Sisters do all the nursing, having no 
servants about the patients, wear the prettiest white 
linen habits, and explain freely the orders and treat- 
ment of the cases in the French language with a soft 
touch of Irish brogue. So progresses the revolution, 
and over every hospital stand the glorious words: 
Liberte; Egalite; Fraternite. 

CENTRAL RESERVE 
STH IAVE, ;ft 42ND ST,, ROOM 

END OF VOLUME III. 










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